Learning objectives
Assess the efficacy of percutaneous vacuum assisted excision of small intraductal papilloma,
either incidentally identified on screening or in diagnostic examinations.
Evaluate the technique,
pitfalls,
complications and pathological correlationof this technique as a viable alternative to surgery.
The procedural costs,
advantages,
and limitations would be discussed and compared to available surgical options.
Background
Intraductal papillomas (IDP) are commonlyencountered in routine breast ultrasound,
especiallyin patients presenting withnipple discharge.
IDP is typically small,
hypoechoeic,
round or ovoid in shape,
and arises withina breastduct. It is oftenassociated withproximal ductal distention.
On mammography,
IDP may beidentified as a nodular mass,
with or without calcifications.
All IDPs excised at our Institution are all biopsy-proven papillomas without atypia.
Vacuum assisted core biopsy is an accepted technique for sampling microcalcifications under stereotactic guidance.
Using the same device,
benign IDP can be excised,
with good clinical...
Imaging findings OR Procedure details
Consultation made with the patient and the procedure explained.
Written consent obtained.
Previous imaging and histological report reviewed.
Selection criteria:
Lesions smaller than 2 cm at our institute.
Biopsy provenPapillomas without atypia.
Approach:
Based on lesion location,
usually from the side of the lesion with adequate tract to preferable place the needle under the lesion.
Roll the patient so that the breast are stretched out and are gravity dependant for easy access.
Challenges of percutaneous technique of performing vacuum guided:
Large lesion.
Leasion in the...
Conclusion
Conclusion:
Vacuum assisted excision of intraductal papillomas can become the mainstay of treatment for non-malignant papilloma without any atypia on pre-exision biopsy.
Most of these lesions are identified incidentally on screening population and some of them present with nipple discharge.
Radiologist should not only play an important role in detection of these lesions but also in guiding management by offering this minimally invasive,
outpatient technique to patients as an alternative to surgery.
A VAE is less invasive than surgical excision of the lesion.
It is...
Personal information
A Varma is a Consultant Radiologist with special interest in Body,
Breast and Oncologic imaging.
Working at Mater hospital and Prince Charles Hospitals QLD.
P.
Chou is a consultant radiologist with special interest inWomen's imaging and breast imaging including interventional.
Working at Mater hospital and Prince Charles Hospitals QLD.
References
References:
Management of ultrasonographically detected benign papillomas of the breast at core needle biopsy.
AJR 2011; 196 : 723-729
Large volume “mammotome “ biopsy may reduce the need for diagnostic surgery in papillary lesions of the breast .
J Clin Pathol 2008; 61: 928 – 933.
Sonographically Guided Vacuum-Assisted Breast Biopsy for Complete Excision of Presumed Benign Breast Lesions.
J Ultrasound Med 2012; 31:1951–57.
The current role of vacuum assisted breast biopsy system in breast disease.
J Breast Cancer 2011; 14:1–7.
Factors Affecting the Efficacy...