Elles van de Voort, MSc1
1Franciscus Gasthuis & Vlietland Hospital, Rotterdam, the Netherlands.
The aim of this study is to describe the impact of introducing vacuum-assisted excision (VAE) as a treatment for benign and high-risk lesions on the management and outcomes of these lesions.
This was a single-center, retrospective cohort study with 2 groups. Included were all women ( 16 years) treated for a benign or high-risk lesion. VAE was introduced as a treatment for these lesions in July 2017. The “before” group (BG) included all surgically excised (SE) lesions from January 2016 through June 2017. The “after” group (AG) included all lesions excised utilizing SE or VAE from July 2017 through December 2019. VAE was contraindicated when the tumor was located in proximity to the skin or nipple. Relative contraindications were poor visibility on ultrasound, tumor size > 5 cm, and mobility of the lesion. To evaluate the impact of the introduction of VAE, the proportion of excised lesions and the rates of incomplete excision, recurrence, re-excision, and complications were compared between the 2 groups.
Included were 330 excised lesions in 282 patients. The proportion of excised lesions of all biopsies was higher in the AG (227/1258; 18%) than the BG (103/765; 13%) (P = .007). However, the absolute number of surgical excisions in the operating room decreased after introduction of VAE (65 vs 45 per year, for the BG and AG, respectively). Incomplete excision occurred significantly more in the BG (n = 18; 19%), compared with the AG (n = 15; 7.1%; P = .002), but the number of recurrent lesions was comparable in both groups (BG, 2.9% at a median follow-up of 46 months, vs AG, 0.9% at a median follow-up of 23 months; P = .162). Nine re-excisions were performed, which were evenly distributed over the BG and AG (3.9% vs 2.2%, respectively; P = .385). The proportion of complications was comparable in the BG and AG (4/89 [4.5%] vs 13/205 [6.3%], respectively; P = .805). Complications after SE occurred less frequently but were more severe compared with complications after VAE.
The introduction of VAE led to an absolute decrease of benign excisions in the operating room, leaving more time for patients with malignant disease. Although no margin assessment was possible at histologic evaluation after VAE, this did not lead to an increased recurrence rate. With the current shift toward treatment of a less-invasive nature, and ongoing studies on reducing overtreatment of lesions with a low risk of developing into carcinoma, we expect that even more lesions can be excised with VAE in the future.