caa a22 4500 44533911X CHVBK 20180317142806.0 cr unu---uuuuu 170323e20111001xx s 000 0 eng 10.1245/s10434-011-1911-0 doi (NATIONALLICENCE)springer-10.1245/s10434-011-1911-0 Definitive Diagnosis for High-Risk Breast Lesions Without Open Surgical Excision: The Intact Percutaneous Excision Trial (IPET) [Elektronische Daten] [Pat Whitworth, Jean Simpson, William Poller, Steven Schonholz, John Turner, Rogsbert Phillips, Joel Johnson, F. McEachin] Background: Open surgical excision (OSE) is generally recommended when image-guided core-needle breast biopsy demonstrates a high-risk lesion (HRL). We evaluated intact percutaneous excision (IPEX) with standard radiologic and histologic criteria for definitive diagnosis of HRL, particularly atypical ductal hyperplasia (ADH). The primary aim is to confirm criteria associated with <2% risk for upgrade to carcinoma, equivalent to risk associated with Breast Imaging Reporting and Data System (BI-RADS) 3 lesions, for which imaging surveillance is considered sufficient. Methods: In a prospective trial, 1,170 patients recommended for breast biopsy at 25 institutions received IPEX with a vacuum- and radiofrequency-assisted device. ADH patients in whom the imaged lesion had been removed and the lesion adequately centered for definitive characterization were designated as the potential surgical avoidance population (PSAP) before OSE. Subsequent OSE specimen pathology was compared with IPEX findings. Results: In 1,170 patients, 191 carcinomas and 83 (7%) HRL, including 32 ADH (3%), were diagnosed via IPEX. None of the 51 non-ADH HRL were upgraded to carcinoma on OSE (n=24) or, if OSE was declined, on radiologic follow-up (n=27). No ADH lesions meeting PSAP criteria (n=10) were upgraded to carcinoma on OSE; 3 (14%) of 22 non-PSAP ADH lesions were upgraded to carcinoma on OSE. In summary, no upgrades to carcinoma were made in patients with non-ADH lesions who underwent IPEX or in ADH patients who had IPEX, met histologic and radiologic criteria, and underwent OSE or follow-up. Conclusion: IPEX combined with straightforward histologic and radiologic criteria and imaging surveillance constitutes acceptable management of image-detected HRL, including ADH. Society of Surgical Oncology, 2011 Whitworth Pat Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA aut Simpson Jean Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN, USA aut Poller William Breast Care Center, Allegheny General Hospital, Pittsburgh, PA, USA aut Schonholz Steven Breast Care Center, Mercy Medical Center, Springfield, MA, USA aut Turner John Thyra M. Humphreys Center for Breast Health, Evangelical Community Hospital, Lewisburg, PA, USA aut Phillips Rogsbert Metro Surgical Associates, Lithonia, GA, USA aut Johnson Joel Department of Surgery, Tift Regional Medical Center, Tifton, GA, USA aut McEachin F. Department of Surgery, Tift Regional Medical Center, Tifton, GA, USA aut Annals of Surgical Oncology Springer-Verlag 18/11(2011-10-01), 3047-3052 1068-9265 18:11<3047 2011 18 10434 https://doi.org/10.1245/s10434-011-1911-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1911-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Whitworth Pat Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA aut NATIONALLICENCE 700 1- Simpson Jean Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN, USA aut NATIONALLICENCE 700 1- Poller William Breast Care Center, Allegheny General Hospital, Pittsburgh, PA, USA aut NATIONALLICENCE 700 1- Schonholz Steven Breast Care Center, Mercy Medical Center, Springfield, MA, USA aut NATIONALLICENCE 700 1- Turner John Thyra M. Humphreys Center for Breast Health, Evangelical Community Hospital, Lewisburg, PA, USA aut NATIONALLICENCE 700 1- Phillips Rogsbert Metro Surgical Associates, Lithonia, GA, USA aut NATIONALLICENCE 700 1- Johnson Joel Department of Surgery, Tift Regional Medical Center, Tifton, GA, USA aut NATIONALLICENCE 700 1- McEachin F. Department of Surgery, Tift Regional Medical Center, Tifton, GA, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/11(2011-10-01), 3047-3052 1068-9265 18:11<3047 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer