Successful introduction of the Vacuum Excision (VACE) pathway for the management of screen detected breast lesions of uncertain malignant potential (B3)
Association of Breast Surgery ePoster Library. Tang S. 05/15/17; 166177; P028
Ms. Sarah Tang
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Abstract
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Introduction
6.7% of screen-detected lesions are categorised as B3 (1). Until recently, surgical excision was the diagnostic procedure of choice, with the intention of removing lesions for full histological assessment in order to exclude co-existing malignancy (upgrade). Wide bore vacuum-assisted needle biopsy techniques provide an alternative and cost-effective non-surgical method for the provision of greater volumes of tissue. A VACE pathway has been introduced at St George's Hospital and we present the data for the first year in practice.
Results
There were 104 patients in the pathway (3/9/2015 - 22/8/2016). The median age was 57years (range 41-75). The intervals between the pathway events are presented (Table 1). Seventy patients presented with calcification, 23 with a mass and 7 with distortion. The median lesion size was 8mm (2-105). Following VACE, 17 cases were upgraded (B5a/B5b). Of these,14 were upgraded to DCIS, 2 were upgraded to IDC and there was one case of pleomorphic LCIS. At surgery, no further upgrades were found. No residual disease was seen in 2 cases. No recurrences were seen at follow-up (mean 196 days, range 72-328).
Conclusion
Over 100 patients were successfully managed in the pathway. 86 patients avoided unnecessary surgery, representing significant direct cost savings as well as indirectly freeing up operating space and reducing 62 day breaches. This is a complex pathway with multiple components. The main delay was identified between core biopsy and VACE. It is anticipated that increasing capacity for VACE procedures will reduce this delay in the future.
6.7% of screen-detected lesions are categorised as B3 (1). Until recently, surgical excision was the diagnostic procedure of choice, with the intention of removing lesions for full histological assessment in order to exclude co-existing malignancy (upgrade). Wide bore vacuum-assisted needle biopsy techniques provide an alternative and cost-effective non-surgical method for the provision of greater volumes of tissue. A VACE pathway has been introduced at St George's Hospital and we present the data for the first year in practice.
Results
There were 104 patients in the pathway (3/9/2015 - 22/8/2016). The median age was 57years (range 41-75). The intervals between the pathway events are presented (Table 1). Seventy patients presented with calcification, 23 with a mass and 7 with distortion. The median lesion size was 8mm (2-105). Following VACE, 17 cases were upgraded (B5a/B5b). Of these,14 were upgraded to DCIS, 2 were upgraded to IDC and there was one case of pleomorphic LCIS. At surgery, no further upgrades were found. No residual disease was seen in 2 cases. No recurrences were seen at follow-up (mean 196 days, range 72-328).
Conclusion
Over 100 patients were successfully managed in the pathway. 86 patients avoided unnecessary surgery, representing significant direct cost savings as well as indirectly freeing up operating space and reducing 62 day breaches. This is a complex pathway with multiple components. The main delay was identified between core biopsy and VACE. It is anticipated that increasing capacity for VACE procedures will reduce this delay in the future.
Introduction
6.7% of screen-detected lesions are categorised as B3 (1). Until recently, surgical excision was the diagnostic procedure of choice, with the intention of removing lesions for full histological assessment in order to exclude co-existing malignancy (upgrade). Wide bore vacuum-assisted needle biopsy techniques provide an alternative and cost-effective non-surgical method for the provision of greater volumes of tissue. A VACE pathway has been introduced at St George's Hospital and we present the data for the first year in practice.
Results
There were 104 patients in the pathway (3/9/2015 - 22/8/2016). The median age was 57years (range 41-75). The intervals between the pathway events are presented (Table 1). Seventy patients presented with calcification, 23 with a mass and 7 with distortion. The median lesion size was 8mm (2-105). Following VACE, 17 cases were upgraded (B5a/B5b). Of these,14 were upgraded to DCIS, 2 were upgraded to IDC and there was one case of pleomorphic LCIS. At surgery, no further upgrades were found. No residual disease was seen in 2 cases. No recurrences were seen at follow-up (mean 196 days, range 72-328).
Conclusion
Over 100 patients were successfully managed in the pathway. 86 patients avoided unnecessary surgery, representing significant direct cost savings as well as indirectly freeing up operating space and reducing 62 day breaches. This is a complex pathway with multiple components. The main delay was identified between core biopsy and VACE. It is anticipated that increasing capacity for VACE procedures will reduce this delay in the future.
6.7% of screen-detected lesions are categorised as B3 (1). Until recently, surgical excision was the diagnostic procedure of choice, with the intention of removing lesions for full histological assessment in order to exclude co-existing malignancy (upgrade). Wide bore vacuum-assisted needle biopsy techniques provide an alternative and cost-effective non-surgical method for the provision of greater volumes of tissue. A VACE pathway has been introduced at St George's Hospital and we present the data for the first year in practice.
Results
There were 104 patients in the pathway (3/9/2015 - 22/8/2016). The median age was 57years (range 41-75). The intervals between the pathway events are presented (Table 1). Seventy patients presented with calcification, 23 with a mass and 7 with distortion. The median lesion size was 8mm (2-105). Following VACE, 17 cases were upgraded (B5a/B5b). Of these,14 were upgraded to DCIS, 2 were upgraded to IDC and there was one case of pleomorphic LCIS. At surgery, no further upgrades were found. No residual disease was seen in 2 cases. No recurrences were seen at follow-up (mean 196 days, range 72-328).
Conclusion
Over 100 patients were successfully managed in the pathway. 86 patients avoided unnecessary surgery, representing significant direct cost savings as well as indirectly freeing up operating space and reducing 62 day breaches. This is a complex pathway with multiple components. The main delay was identified between core biopsy and VACE. It is anticipated that increasing capacity for VACE procedures will reduce this delay in the future.
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