Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience

Aim

To review the outcome of vacuum-assisted removal of breast papillomas performed in the Bolton Breast Unit.

Materials and methods

Twenty-six benign breast papillomas were excised using an ultrasound-guided, vacuum-assisted technique under local anaesthetic over a 6-year period. An 8 G Mammotome was used for 12 lesions, an 11 G Mammotome for 13 lesions and a 7 G EnCor for one lesion. The mean lesion size was 9 mm (range 3–17 mm). The mean number of cores taken per case was nine.

Results

One patient developed a post-procedure haematoma, which did not require treatment. There were no other short-term complications. None of the papillomas were associated with atypia or malignancy. Subsequent breast imaging (mostly routine screening mammography) was reviewed and evidence of recurrence recorded. To date, 16 patients have received at least one subsequent routine screening mammogram, with a mean follow-up to latest mammogram of 30 months. Mammographic evidence of papilloma regrowth has been observed in two patents, with a third patient presenting with recurrence of the original symptom of a palpable lump. All three recurrent lesions were surgically excised and confirmed to be benign papillomas. These lesions measured 6, 12, and 15 mm prior to the original vacuum-assisted excision.

Conclusion

The findings suggests that vacuum-assisted removal is a satisfactory alternative to surgery for the majority of patients, but that particular attention should be paid to ensuring complete lesion removal in view of the relatively high recurrence rate in this series.

Introduction

Papillomas are relatively uncommon benign neoplasms of the breast. The diagnosis is usually made as a result of the detection of an asymptomatic mass or focus of microcalcification on routine screening mammography, although sometimes papillomas can present with symptoms such as nipple discharge, bleeding from the nipple, or a palpable mass. Conventional management generally involves percutaneous image-guided needle biopsy of the lesion. A diagnosis of a papillary lesion on core biopsy is then usually followed by surgical excision because of the risk of associated malignancy.

Large-bore, image-guided, vacuum-assisted biopsy has become established in recent years as a safe, cost-effective alternative to open surgery for the removal of certain benign breast lesions, such as fibroadenomas. A number of biopsy devices are now commercially available, including the Mammotome^® (Ethicon EndoSurgery, Cincinnati, OH, USA), the ATEC^® (Hologic, Indianapolis, IN, USA), the EnCor^® (SenoRx, Irvine, CA, USA), and the Vacora^® (Bard Biopsy Systems, Tempe, AZ, USA). Needles (known also as probes) range in size from 7–14 G. The aim of this study was to review the medium-term results in patients in whom papillomas were removed using this technique.