Office-based ultrasound-guided cryoablation of breast fibroadenomas

BACKGROUND: Fibroadenomas commonly found by palpation and routine mammography account for approximately 20% of open surgical breast biopsies. Alternatives to open surgery include tumor removal using an automated coring device and tumor ablation using heating or cooling elements. We report our initial experience with cryoablation of biopsy-proven benign fibroadenomas. METHODS: A table-top cryoablation system employing a 2.4-mm cryoprobe was used to treat biopsy-proven benign fibroadenomas up to 4 cm in maximum diameter in a prospective nonrandomized fashion. The cryoprobe was placed under ultrasound guidance. Using a treatment algorithm based on fibroadenoma size, all tumors were subjected to two freeze cycles with an interposing thaw. Skin appearance and temperature, probe temperature, iceball size, and patient comfort were closely monitored during the procedure. Follow-up examinations including ultrasonography and photographs were scheduled for up to 12 months postablation. RESULTS: Fifty patients with 57 core biopsy-proven benign fibroadenomas were treated. Seven early cases were treated in an ambulatory surgery center setting. The remaining procedures were completely office-based using only local anesthetic. Tumor diameter varied from 7 mm to 42 mm (mean 21 mm). The iceball engulfed the target lesion in each case. Transient postoperative side effects were local swelling and ecchymosis. Postoperative discomfort rarely required medication beyond acetaminophen or ibuprofen. Lesions showed progressive shrinkage and disappearance over 3 to 12 months. No skin injury was noted and appearance remained excellent. Patient satisfaction was excellent. CONCLUSIONS: With office-based use of ultrasound-guided cryoablation for fibroadenomas there was little or no pain, target lesions were reduced in size or eliminated, scarring was minimal, cosmesis outstanding, and patient satisfaction was excellent. Cryoablation offers a useful office-based alternative to surgical excision of benign fibroadenomas.     

Office-based cryoablation of breast fibroadenomas: 12-month followup

BACKGROUND: Fibroadenomas comprise between 30% and 50% of all breast biopsies. Despite their benign nature, many women have their fibroadenomas surgically removed. We previously reported on a minimally invasive therapy using cryoablation to treat fibroadenomas. We now report on 12-month followup using this technique. STUDY DESIGN: A prospective, nonrandomized trial was initiated in June 2000 with IRB approval. The Visica Treatment System was used to cryoablate 70 biopsy-proved fibroadenomas in 57 patients using a freeze-thaw-freeze cycle lasting 6 to 30 minutes. Each patient was serially evaluated for safety, efficacy, and satisfaction. RESULTS: Fifty-seven fibroadenomas (mean 2.1 cm, range 0.8 to 4.2 cm) in 47 patients were followed for 12 months. At 1 year, with 89% median tumor volume reduction measured by ultrasonography, 75% of fibroadenomas were nonpalpable. There were no adverse events and only minor complications. Two patients (4%) had their lesions excised after 12 months; pathology revealed no viable fibroadenoma. Serial mammograms showed resorption of the fibroadenoma leaving minimal residual density without calcifications. Cosmesis was excellent with no volume deficit, as no tissue is removed. Ninety-one percent of patients were satisfied at 12 months. CONCLUSIONS: Cryoablation is safe and effective in treating breast fibroadenomas. It offers a nonsurgical, office-based treatment that is well tolerated by patients and accurately monitored with ultrasonographic guidance. At 12 months we found progressive tumor volume reduction and reduced palpability, with no volume deficit, excellent cosmesis, and satisfied patients. Ultrasonography-guided cryoablation is a preferred option for treatment of breast fibroadenomas without open surgery.     

Progressive adoption of cryoablative therapy for breast fibroadenoma in community practice

BACKGROUND: Cryoablation is a recent technological advance and has been used for the percutaneous treatment of breast fibroadenomas. Herein, we provide a retrospective summary of the early experience from a nationwide group. METHODS: We organized a national registry to document the community practice and adoption of an office-based system of cryoablation for breast fibroadenoma. Data were abstracted during the first 6 weeks after the procedure to assess acute outcome and potential complications. At 6-and 12-month follow-up intervals, additional data were collected regarding fibroadenoma resolution, cosmesis, and patient satisfaction. RESULTS: Fifty-three sites ablated 310 fibroadenomas. Early follow-up data on 256 lesions showed that the procedure was well tolerated with infrequent minor complications immediately after the procedure. At 6 and 12 months postprocedure, the remaining fibroadenoma volume progressively involuted. At both intervals, cosmesis was excellent, and patient satisfaction was rated high. CONCLUSIONS: An early community experience with office-based cryoablation of breast fibroadenomas is encouraging and comparable to the initial experience of high-volume tertiary centers. More follow-up is necessary to determine long-term results and residual mammographic changes.     

Interim results from the FibroAdenoma Cryoablation Treatment Registry

OBJECTIVE: The aim of this prospective study was to assess the intermediate- (6 months) and longer-term (12 months) follow-up of patients with breast fibroadenomas treated by cryoablation in community-based practice settings. METHODS: The FibroAdenoma Cryoablation Treatment (FACT) registry was created to systematically collect procedural and follow-up data for patients with fibroadenomas treated by cryoablation without subsequent excision. This report summarizes the experience from 55 different practice settings across the United States. Baseline and follow-up clinical data at 6 months and 12 months were tabulated for all patients. RESULTS: Data from 444 treated fibroadenomas were analyzed. The mean tumor diameter was 1.8 cm. Before cryoablation, 75% of fibroadenomas were palpable by the patient. Follow-up at 6- and 12-month intervals revealed palpability of the treated site in 46% and 35%, respectively. When fibroadenomas were grouped by size, for lesions 2 cm, residual cryoablation induce changes were visible by ultrasound in 39% of the patients at 6 months. The treatment area was palpable in 78% of the cases at the same time. Visibility by ultrasound was 32%, and palpability was 59% at 12 months follow-up. Patient satisfaction with the procedure was rated as high at 91% and 88% at 6 and 12 months follow-up, respectively. CONCLUSIONS: Before implementing this technique, patients should be apprised of the likely persistence of a palpable mass of the treated site for a prolonged period that will reabsorb over time. Palpability of the treated site persists for a substantially longer period of time for lesions greater than 2 cm in diameter. For patients with a fibroadenoma smaller than 2 cm, complete resolution can be expected in two thirds and three quarters of the patients at 6 and 12 months, respectively. We will continue to follow these patients to better define the length of time and factors influencing the resolution of the treatment induced physical and radiographic findings.     

Office-based cryoablation of breast fibroadenomas with long-term follow-up

Approximately 10% of women will experience a breast fibroadenoma in their lifetime. Cryoablation is a new treatment that combines the better attributes of the current standards: surveillance and surgery. It is a minimally invasive office-based procedure that is administered without the use of general anesthesia, involving minimal patient discomfort and little to no scarring. This work aimed to establish the long-term (2-3 years) efficacy, safety, and satisfaction of the procedure, as well as the impact of cryoablation on mammogram and ultrasound images. Thirty-seven treated fibroadenomas were available for assessment with an average follow-up period of 2.6 years. Of the original 84% that were palpable prior to treatment, only 16% remained palpable to the patient as of this writing. Of those fibroadenomas that were initially < or = 2.0 cm in size, only 6% remained palpable. A median volume reduction of 99% was observed with ultrasound. Ninety-seven percent of patients and 100% of physicians were satisfied with the long-term treatment results. Mammograms and ultrasounds showed cryoablation produced no artifact that would adversely affect interpretation. Cryoablation for breast fibroadenomas has previously been reported as safe and effective both acutely and at the 1-year follow-up mark, and thus has been implemented as a treatment option. At long-term follow-up, cryoablation as a primary therapy for breast fibroadenomas demonstrates progressive resolution of the treated area, durable safety, and excellent patient and physician satisfaction. The treatment is performed in an office setting rather than an operating room, resulting in a cost-effective and patient-friendly procedure. Cryoablation should be considered a preferred option for those patients desiring definitive therapy for their fibroadenomas without surgical intervention.     

Diagnosis and treatment of breast fibroadenomas by ultrasound-guided vacuum-assisted biopsy

HYPOTHESIS: Ultrasound-guided vacuum-assisted biopsy (UGVAB) can serve as an efficient tool for the diagnosis and excision of breast fibroadenomas. DESIGN: Patients with a clinically and radiographically suspected breast fibroadenoma were prospectively referred for UGVAB to confirm the diagnosis and to attempt to excise the lesion. PATIENTS: Fifty-two female patients, aged 19 to 68 years, were included in the 2-year study. All had at least 1 suspected fibroadenoma. The procedure was performed for a total of 56 lesions. INTERVENTIONS: Imaging modalities prior to biopsy to confirm the clinical suspicion included Doppler ultrasound and mammography or Doppler ultrasound alone. Tumor size and volume were recorded. Ultrasound-guided vacuum-assisted biopsy was performed in all cases, with guidance using the 11-gauge Mammotome handheld vacuum-assisted biopsy system (Ethicon Endo-Surgery Inc, Cincinnati, Ohio). MAIN OUTCOME MEASURES: Major end points included diagnosis compatibility rate, excision rate, complications, and short-term follow-up. RESULTS: A tissue diagnosis was obtained in all cases and was compatible with the clinical diagnosis of fibroadenoma. Complete excision was achieved in all lesions less than or equal to 1.5 cm (mean volume, 0.25 mL). All lesions greater than 2 cm (mean volume, 1 mL) were incompletely excised. Of the 20 lesions measuring 1.5 to 2.0 cm, 11 (55%) were completely excised. The volume of all completely excised lesions was less than 0.9 mL. Four lesions with a volume less than 0.9 mL were incompletely excised due to bleeding. Ten of the 13 cases with incomplete excision were confident enough with the diagnosis to choose imaging follow-up instead of surgery. Two patients (16%) were referred by the radiologist for surgical excision. Only 1 patient with incomplete removal (8%) felt uncomfortable with the remnant lump and requested surgical excision. CONCLUSIONS: Although the breast fibroadenoma is a common benign breast tumor, the treatment and follow-up of these lesions is still debatable. We suggest that UGVAB, which has a well-documented role in the diagnosis of breast lesions, may provide an option for the definitive treatment of breast fibroadenomas.     

Percutaneous radiofrequency-assisted excision of fibroadenomas

INTRODUCTION: Fibroadenomas are a frequently encountered benign tumor that will occur in approximately 10% of women during their lifetime. Although the natural history would suggest fibroadenomas diagnosed with minimally invasive needle core biopsy can be safely observed, the majority are still surgically removed in the operating room. In an effort to limit the more than 500,000 surgical fibroadenoma removals performed each year, percutaneous excision has become a viable alternative. Percutaneous excision of intact fibroadenomas versus removal with a multiple core sampling technique has the dual potential advantage of causing minimal intervention combined with provision of adequate sample for thorough histopathology and margin analysis for confirmation of complete removal. An 18-month retrospective analysis was undertaken to evaluate the utilization of a new radiofrequency-assisted biopsy device in the successful removal and continued absence of histologically confirmed fibroadenomas on 4- to 6-month follow-up imaging. METHODS: Between April 2004 and November 2005, 100 patients underwent ultrasound- or stereotactic-guided, radiofrequency-assisted intact percutaneous excision of 106 diagnosed fibroadenomas of the breast. Patients were comprised of 100 women whose ages ranged from 18-70 years (median age, 45 years). RESULTS: Indications for the procedure included palpable mass, 77; abnormal mammogram, 13; and abnormal ultrasound, 10, as the patient's initial presentation. Ultrasound was used to guide the procedure in 82 patients, and stereotactic was used in 18 patients. One early study procedure was performed under general anesthesia; the remaining studies were performed under local anesthesia (1% lidocaine) using from 10 to 45 mL. On pathologic examination, the tumors ranged in size from 6 to 27 mm (mean diameter, 14 mm) and weighed from 0.6 to 2.0 g (mean weight, 1.0 g). Patients reported minimum discomfort related to the procedure; pain scores ranged from 0 to 10 (mean pain score, <1). Complications were minimal, with only 2 patients having bleeding, which was controlled by conservative measures. At the 4- to 6-month follow-up, 79 of 85 (93%) evaluable patients showed no physical or imaging evidence of residual fibroadenoma, an additional 5 patients have reported no physical findings or further complaints and have required no further need for medical evaluation, 8 have been lost to follow-up, and 2 have yet to be reevaluated. CONCLUSIONS: Percutaneous ultrasound- or stereotactic-guided, radiofrequency-assisted excision of fibroadenomas of the breast may be performed in an ambulatory setting under local anesthesia. The procedure provides intact specimens that in most cases appear to be completely removed after follow-up of 4 to 6 months. The procedure is well tolerated by patients and is associated with minimal complications.     

乳晕边缘小切口切除乳房多发或巨纤维腺瘤

目的探索采用乳晕边缘小切口切除乳房多发或巨大良性纤维腺瘤,达到既切除病灶又能起到美容目的的可行性。方法2006年1月～2008年2月选择46例乳房多发良性纤维腺瘤和2例巨纤维腺瘤（〉7cm）,根据多数肿瘤或巨大肿瘤存在的部位,选择不同象限的乳晕边缘切口,切口长度不超过乳晕周长的1/2。对于多发乳房良性肿瘤,在皮下脂肪和腺体之间潜行游离到肿瘤表面,放射状切开肿瘤表面的腺体,将肿瘤完整切除;对于巨大良性肿瘤,同法切开腺体至肿瘤表面,将肿瘤分块全部切除。结果46例多发乳房纤维腺瘤共计切除肿瘤165个,其中1例双侧乳房肿瘤数量达19个,均完整切除;乳房巨纤维腺瘤2例,肿瘤最大直径8cm,也将肿瘤完整切除。乳晕边缘切口长度〈3.5cm,术后均未发生乳头坏死。48例随访1～24个月,平均14.4月,11例切口瘢痕不明显,26例注意观察才能发现切口瘢痕,9例比较容易看到切口瘢痕,2例因瘢痕体质切口瘢痕明显。结论乳晕边缘小切口切除乳房多发或巨纤维腺瘤,手术方法简便易行,可达到较好的美容效果,值得推广。     

Cryoablation of benign breast tumors: evolution of technique and technology

We report on improvements in cryoprobe design and techniques of cryoablation as a minimally invasive alternative to open surgery for the treatment of benign breast tumors. In the study, which was conducted in 12 centers, 124 lesions in 102 patients were monitored for a period of 12 months after cryoablation. Two different treatment techniques were used: Double HI FREEZE and Tailored Freeze. In patients treated with the Tailored Freeze technique significantly better results were recorded 12 months after the procedure: the median reduction in tumor volume was 91%, 73% of all tumors treated were nonpalpable, 84% of lesions less than 2.5 cm in maximum diameter were nonpalpable, and none of the 31 mammograms performed yielded abnormal findings. Patient satisfaction was good to excellent in 92% of the patients. The safety profile of this technique was excellent; all complications were minor. Evolution of cryoablation freezing techniques, coupled with improvements in cryoprobe design, has resulted in significant improvements in both safety and effectiveness.     

Low-risk palpable breast masses removed using a vacuum-assisted hand-held device

BACKGROUND: This study evaluates the safety, efficacy, and patient acceptance of a vacuum-assisted, hand-held biopsy device (Mammatome) in the percutaneous removal of breast masses using ultrasound guidance. METHODS: A multicenter, nonrandomized study evaluated 216 women with low-risk palpable lesions. Lesions 1.5 to 3.0 cm in size were removed using an 8-gauge probe. Those lesions <1.5 cm were removed with the 11-gauge probe. Follow-up evaluation was performed at 10 days and 6 months after biopsy. RESULTS: A total of 127 patients had biopsies using the 8-gauge probe, and 89 patients had biopsies using the 11-gauge probe. At 6-month follow-up, 98% of the lesions remained nonpalpable, 73% with no ultrasonographically visible evidence of the original lesion. Most complications were mild and anticipated. Most patients (98%) were satisfied with incision appearance, and 92% of patients would recommend the procedure to others. CONCLUSIONS: Percutaneous removal of palpable benign breast masses using the Mammotome system is feasible and safe, and yields high patient satisfaction. The results at 6 months after biopsy demonstrated the effectiveness of benign lesion removal, with correlative clinical data demonstrating lack of palpability and no need for additional procedures. Continuing evaluation of long-term efficacy is ongoing.     

Ultrasound-guided, vacuum-assisted excision in the diagnosis and treatment of clinically benign breast lesions

INTRODUCTION

Ultrasound-guided, vacuum-assisted biopsy has a definitive role in the diagnosis of breast lesions. Its role in the treatment of benign breast lesions like fibroadenomas has not been established.

PATIENTS AND METHODS

This is a retrospective review of patients undergoing ultrasound-guided, vacuum-assisted biopsy for clinically benign breast lesions. The procedures were performed in all cases by two consultant radiologists with special interest in breast radiology between February 2002 and January 2004. Patients were followed up in the clinic 6 weeks after the procedure.

RESULTS

Seventy-six patients had ultrasound-guided, vacuum-assisted excision of clinically benign breast lesions during this 2-year period. Mean age of the patients was 31 years. Altogether, 86 procedures were performed. Six patients with larger lesions (> 2 cm) had two procedures on separate sitting and 4 patients had separate lesions excised on a later date. Fifty-six patients were identified to have fibroadenomas and had complete excisions as evidenced on scan. Three out of nine patients identified with equivocal disease on fine needle aspiration cytology (FNAC) were found to have cancer following ultrasound-guided, vacuum-assisted excision. One patient who was diagnosed with cancer on FNAC, proved to be fibroadenoma on final histopathology. Four patients developed haematomas following ultrasound-guided, vacuum-assisted excision and all were managed conservatively.

CONCLUSIONS

Our study shows that ultrasound-guided, vacuum-assisted excision can play an efficient role in the diagnosis of benign breast lesions and is a safe and successful alternative in treatment of fibroadenomas.     

Comparative analysis of molecular alterations in fibroadenomas associated or not with breast cancer

HYPOTHESIS: The cause of breast cancer is linked to many macroscopic events, including benign breast disease. In this study we asked whether molecular changes could discriminate fibroadenoma, which is one of the most common benign breast disease lesions associated or not with breast cancer. DESIGN: Retrospective cohort study. SETTING: Anticancer medical center. SUBJECTS: Archival tissues in 32 cases of fibroadenoma, diagnosed in the same breast as a breast carcinoma, are compared with a control group of 26 cases of fibroadenomas unaffected by breast cancer. MAIN OUTCOME MEASURES: Histological features are characterized in all samples. The epithelial and stromal components are analyzed for a loss of heterozygosity and a microsatellite instability using a polymerase chain reaction-based method with 11 polymorphic microsatellite markers at 7 chromosomal regions frequently altered in breast cancer. The p53 gene mutations were also determined at exons 5 to 9. RESULTS: The frequency of complex fibroadenomas was similar in both groups (P =.42). Only in the case group did we observe proliferative lesions confined in fibroadenomas, including atypical ductal hyperplasia (2 cases), lobular neoplasia (3 cases), or low-grade ductal carcinoma in situ (2 cases). There is no significant morphological difference between the 2 groups. Neither microsatellite alterations nor p53 gene mutations are present in the fibroadenoma components. Loss of heterozygosity is found only in the epithelial component of the 2 ductal carcinomas in situ confined in fibroadenomas. CONCLUSIONS: Genetic alterations, which are most frequently involved in malignant breast carcinomas, are not present in fibroadenomas, regardless of their association with breast cancer or their histological complexity. These findings suggest that fibroadenomas are not associated with breast carcinogenesis.     

99mTc-甲氧基异丁基异腈显像诊断乳房肿块的临床价值

目的 评价^99mTc-甲氧基异丁基异腈（MIBI）显像鉴别乳房肿块良恶性的价值。方法 对106例乳房肿块行^99mTc-MIBI显像检查,全部病例均经手术治疗,与病理结果比较,结果 106例中乳腺癌56例,显像阳性48例,假阴性主要为肿块较小的乳腺癌;良性病变50例,显像阴性40例,假阳性主要为血供丰富的大纤维腺瘤。该法诊断乳腺癌的灵敏度为85.7%,特异性为80.0%,阳性预告值82.8%、阴性预告值83.3%、总正确诊断率为83.0%。结论 ^99mTx-MIBI显像是鉴别乳房良恶性肿块的有效的、无创性检查方法,但对大纤维腺瘤和较小的恶性肿块诊断作用较差。     

Juvenile fibroadenoma of the breast: Treatment and literature review

It is uncommon to find palpable breast masses in young patients. Generally, such masses are benign. Juvenile fibroadenoma is the most frequent benign tumour of the breast. The present report describes a case involving a 17-year-old girl with unilateral right breast hypertrophy, for whom resection and breast reduction was effectively achieved.Resection was combined with an aesthetically pleasing outcome through breast reduction, via a wise pattern of reduction with a superior pedicle.While young patients rarely present with breast masses, the consideration of fibroadenoma in these cases is always warranted. The disconcerting appearance of the breasts for adolescents afflicted by such benign masses underscores the importance of achieving aesthetically optimal outcomes and attaining adequate tumour resection for diagnostic purposes through pathological specimens. In the present case, the young patient underwent a procedure that fulfilled both of these valuable goals through careful pre-operative planning, pedicle selection and skin resection patterns.     

超声引导下Mammotome旋切系统在乳腺纤维腺瘤中的应用

目的探讨超声引导下应用Mammotome旋切系统在乳腺纤维腺瘤中的应用价值。方法2007年1月～2008年10月,对183例266个乳腺良性肿瘤进行超声引导下Mammotome微创旋切术,直径4～25 mm,其中≤10 mm 73个,10～20 mm148个,≥20 mm45个。结果266个乳腺病灶均被Mammotome微创旋切系统完全切除,平均旋切15次（5～44次）,手术时间26 min（10～60 min）。2例轻度皮下淤血,余无并发症。瘢痕长2.5～4 mm,隐蔽。183例随访2～22个月,平均12个月,均应用超声检查,BI-RADS评级Ⅰ～Ⅱ级,未提示局部复发。结论应用Mammotome微创旋切系统切除适当大小乳腺纤维腺瘤,可完全切除病灶并获得理想美容学效果,并发症少。多发纤维腺瘤的手术经验尚需进一步探索总结。     

超声引导下定位导丝辅助在临床触诊阴性的乳腺病灶切除的应用及意义

目的探讨超声引导下定位导丝辅助在临床触诊阴性的乳腺病灶切除的应用价值。方法对2009年9月～2011年10月35例47个触诊阴性的乳腺病灶在超声引导下穿刺病灶并用金属导丝标记定位,切除病灶,明确病理诊断。结果定位全部成功,定位操作时间3～7 min,平均4 min,且无并发症出现。35例47个病灶经超声引导下导丝定位后全部准确切除。术中冰冻病理诊断：浸润性导管癌1例,随即在全身麻醉下行根治手术;乳腺导管内癌1例,随即行单纯乳腺切除术;乳腺纤维腺瘤15例;乳腺病伴纤维腺瘤形成7例;乳腺病增生结节5例;乳腺囊肿4例;乳管内乳头状瘤2例。冰冻切片病理检查与术后石蜡病检结果一致。结论超声引导下定位导丝辅助临床触诊阴性的乳腺病灶切除定位较准确,对良性病变可缩小手术切除范围,对恶性病变可早发现,是一种简单、准确、安全及实用的方法。     

超声引导微创旋切术治疗乳腺肿块220例报道

目的探讨超声引导下微创旋切系统在乳腺肿块诊断和治疗中的价值。方法对我院2006年10月～2010年3月经超声引导Mammotome微创旋切术治疗的乳腺肿块220例疗效进行回顾性分析。临床可触及肿块137例,不可触及而超声检查出肿块83例。220例中有病灶共287个,单发病灶153例,多发(2～5个)病灶67例,肿块0.1～2.8cm。结果所有乳腺病灶被准确完全切除。切除组织标本均行病理检查,乳腺纤维腺瘤225个,乳腺腺病22个,乳腺腺病伴纤维腺瘤形成17个,乳腺囊肿11个,导管内乳头状瘤8个,早期乳腺癌4个(4例,经再次手术局部切除、保乳,无针道种植)。局部血肿2例,经局部引流治愈。全组随访3～36个月,平均17个月,1例术后3个月局部复发(可能为残余肿瘤组织生长),再次微创旋切。结论超声引导微创旋切术治疗乳腺肿块是一项创伤小、并发症少、安全有效的微创技术,对良性肿瘤能够完全切除;对恶性肿瘤提供足够的病理组织。     

手持式Mammotome系统在乳腺微创外科中的应用

目的 探讨B超引导下Mammotome系统对乳腺实质病灶的诊治价值及操作技巧。方法对81例87处乳腺病灶行B超引导下Mammotome微创旋切术，评价其对乳腺病灶的诊治效果。结果所有病灶均成功切除。87处乳腺病灶中，70处为纤维腺瘤，6处为腺瘤样增生，8处乳腺增生，1处为重度不典型增生，1处为乳头状增生活跃，1处为乳腺癌。结论手持式Mammotome微创旋切系统可有效治疗乳腺纤维瘤；能明确诊断可疑病灶，降低良性病变手术率。若为恶性可确定癌组织生物学特性并据此进行新辅助治疗。     

乳腺良性病灶的微创手术

目的：探讨B超引导下Mammotome微创旋切系统对乳腺良性病灶的应用价值，及其与常规手术对比的优点。方法：将行B超引导下Mammotome微创旋切65例84处乳腺良性病灶与同期行常规门诊手术的482例535处乳腺良性病灶作对比，评价它们的诊治效果。结果：65例84处乳腺病灶均被Mammotome微创旋切术切除．平均旋切15次，用时26min；操作无一例失败。与常规门诊手术比较，这种方法皮肤伤口小，除6例有轻度皮下淤血外无其他并发症。结论：用B超引导下的Mammotome微创旋切术行乳腺纤维腺瘤微创切除，与常规门诊手术相比，其近、远期效果相同，但手术疤痕较小，减轻了病人的痛苦。     

Long-term outcome of benign fibroadenomas treated by ultrasound-guided percutaneous excision

Abstract:  Surgical as well as conservative treatment has been described for fibroadenomas. Both have disadvantages. A minimally invasive treatment, ultrasound-guided, vacuum-assisted percutaneous excision has been shown to facilitate the removal of all imaged evidence of benign breast lesions, including fibroadenomas up to 3 cm in diameter. This study is performed to assess the long-term outcome of ultrasound-guided percutaneous excision as a minimally invasive treatment for fibroadenomas. A retrospective review of 69 consecutive fibroadenomas treated with ultrasound-guided percutaneous excision between May, 2001 and December, 2005 was carried out. All these lesions underwent percutaneous excision of all imaged lesion evidence. Clinical and sonographic follow-up was recommended for all patients every 6 months. Initial size, location, and patient age were recorded for each treated lesion. Of 69 lesions treated, 52 were available for follow-up. The median follow-up period was 22 months, with a range of 7 to 59 months. At 6 months, there were no fibroadenoma recurrences. Follow-up sonography demonstrated recurrences in 13 lesions distributed across eight patients. The overall recurrence rate was 15% (8/52) with an actuarial recurrence rate of 33% at 59 months. All of the recurrences were in lesions which were larger than 2 cm in size at initial presentation. Our data suggest that the mechanism of recurrence is the regrowth of retained lesion fragments too small to be detected by ultrasound—not the incomplete excision of all imaged lesion evidence. Despite successful percutaneous excision, fibroadenomas do recur. Lesions smaller than 2 cm in size, so treated, do not need additional therapy or surveillance. Fibroadenomas larger than 2 cm are prone to recurrence and require additional treatment.