Effectiveness of the diagnostic pathway of BLES: could it be safely used as a therapeutic method in selected benign lesions?

Özet

PURPOSEIn this study, we aimed to investigate the breast lesion excision system (BLES) as a tool and apractical alternative technique to surgical biopsy and other percutaneous biopsy methods forsuspicious lesions. We also wanted to share our initial experience with BLES and compare it withstandard percutaneous biopsy methods.METHODSFrom July 2015 to December 2016, a total of 50 patients who had high-risk lesions which werediagnosed with core needle biopsy (CNB) or had lesions with radiology pathology discordance,or had high-risk factors, high-grade anxiety, or suspicious follow-up lesions were enrolled in thestudy. These lesions were classified as Breast Imaging Reporting and Data System (BI-RADS) 3 or 4,which are under 2 cm. Pathologic diagnoses before and after BLES were evaluated comparatively.The diagnostic and therapeutic success and the complications of CNB and BLES were analyzed.RESULTSAfter BLES, two cases were diagnosed as atypical lobular hyperplasia and atypical ductal hyperplasia. Since the surgical margin was negative, re-excision was not required. Two cases werediagnosed as malignant, and no residual tissue was detected in the operation region. Total excision rates were reported as 56%. Minor hematoma was observed in only 1 out of 50 cases(2%), and spontaneous remission was observed. Two patients (4%) complained of pain duringthe procedure. Radiofrequency-related thermal damage to the specimen showed: Grade 0 ( 1.5 mm or thermal damage indiffuse areas) in 2%, and Grade 3 (diffuse thermal damage or inability to diagnose) in 0%. Wefound a significant positive correlation between classification of thermal damage and lesion fatcell content (r = 0.345, P = 0.015).CONCLUSIONBLES is a safe technique that can be effectively used with low complication rates in the excision ofbenign and high-risk breast lesions in selected cases. It may also provide high diagnostic successand even serve as a therapeutic method in high-risk lesions, such as radial scar, papilloma, andatypical lobular hyperplasia with high complete excision rates without fragmentation of lesions.