Dottorato in TECNOLOGIE AVANZATE IN CHIRURGIA

Titolo della tesi: Utilizzo della biopsia escissionale vuoto-assistita con ago da 8 Gauge eseguita sotto guida ecografica come metodica innovativa per il trattamento di lesioni mammarie tipizzate istologicamente come B3.

Objectives: To evaluate the feasibility and the therapeutic efficacy of ultrasound-guided vacuum-assisted excision (VAE) for the treatment of selected breast lesions of uncertain malignant potential (B3). Methods: From December 2017 to December 2019, 52 breast lesions were classified as B3 after core needle biopsy, in our Institution. 11 lesions out of 52 (about 21%) were suitable for ultrasound-guided VAE procedure. Inclusion criteria were B3 breast nodule with dimensions between 5 mm and 25 mm, circumscribed margins and localized at least 5 mm from the skin. A radiological follow-up to evaluate the completeness of excision, the presence of post-procedural hematoma or of a residual/recurrence of disease was performed after 10 and 30 days and 6 and 12 months. All patients were asked to complete a satisfaction questionnaire at the end of the procedure. The costs of VAE were also assessed. Results: Complete excision was achieved in 81.8% of VAE, while in 18.2% (2/11 cases) the excision was incomplete with residual disease. No lesions were upgraded to carcinoma after VAE and no patients had to undergo surgery. No significant complications occurred during or after VAE. All the patients were satisfied with the procedure and the cosmetic result (100%). The costs of VAE resulted to be considerably lower than surgery. Conclusion: VAE proved to be an optimal tool for therapeutic excision of selected B3 lesions, with high accuracy and good patient compliance. For this reason, this technique should be considered in the management of specific breast lesions, as it has the potential to reduce unnecessary surgery, consequently decreasing surgery-related complications and healthcare costs.