Vacuum-assisted excision: a safe minimally invasive option for benign phyllodes tumor diagnosis and treatment-a systematic review and meta-analysis

Abstract

Synopsis: This is a systematic review and meta-analysis comparing surgical excision with percutaneous ultrasound-guided vacuum-assisted excision (US-VAE) for the treatment of benign phyllodes tumor (PT) using local recurrence (LR) as the endpoint.

Objective: To determine the frequency of local recurrence (LR) of benign phyllodes tumor (PT) after ultrasound-guided vacuum-assisted excision (US-VAE) compared to the frequency of LR after surgical excision.

Method: A systematic review and meta-analysis [following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard] was conducted by comparing LR in women older than 18 years treated for benign PT by US-VAE compared with local surgical excision with at least 12 months of follow-up. Studies were retrieved from PubMed, Scopus, Web of Science, and Embase. The pooled effect measure used was the odds ratio (OR) of recurrence.

Results: Five comparative prospective or retrospective observational studies published between January 1, 1992, and January 10, 2022, comparing surgical excision with percutaneous US-VAE for LR of benign PT met the selection criteria. Four were retrospective observational cohorts, and one was a prospective observational cohort. A total of 778 women were followed up. Of them, 439 (56.4%) underwent local surgical excision, and 339 (43.6%) patients had US-VAE. The median age of patients in the five studies ranged from 33.7 to 39 years; the median size ranged from 1.5 cm to 3.0 cm, and the median follow-up ranged from 12 months to 46.6 months. The needle gauge ranged from 7G to 11G. LR rates were not statically significant between US-VAE and surgical excision (41 of 339 versus 34 of 439; OR 1.3; p = 0.29).

Conclusion: This meta-analysis suggests that using US-VAE for the removal of benign PT does not increase local regional recurrence and is a safe minimally invasive therapeutic option.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022309782.

Keywords: local recurrence; meta-analysis; phyllodes tumor; review; vacuum-assisted biopsy; vacuum-assisted excision.

Figure 1

Flowchart of the search results and article selection.

Figure 2

Forest plot of the included studies analyzing the chance of benign PT recurrence. Total of patients = 778. PT, phyllodes tumor.

Figure 3

Funnel plot analysis for symmetry (no publication bias) of the included studies.

Figure 4

A 39-year-old patient presenting a palpable developing mass of 29 mm in the superior outer quadrant of the right breast with previous core needle biopsy of benign PT submitted to US-VAE has been followed up for 3 years without recurrence. (A, B) Mammograms. (C, D) Digital breast tomosynthesis. (E) Ultrasound. The arrow points to the mass that proved to be a benign PT. (F) VAE core sample slide in low-power microscopic field (×40). PT, phyllodes tumor; US-VAE, ultrasound-guided vacuum-assisted excision; VAE, vacuum-assisted excision.

Figure 5

A 45-year-old patient with a developing non-palpable left breast mass of 23 mm initially categorized as ACR BI-RADS 3 diagnosed as fibroadenoma on core needle biopsy. US-VAE diagnosed a borderline PT. Surgery revealed a 3-mm residual borderline PT. (A) Ultrasound. The arrow points to the mass that proved to be a borderline PT. (B, C) Mammograms soon after US-VAE confirmed a successful procedure by no residual lesion and marker well positioned. (D) Surgical excision radiography; the marker proves the precise excision of previous US-VAE site. (E) Lumpectomy surgical specimen. (F) Low-power microscopic field of borderline PT showing focal infiltrative borders. ACR BI-RADS, American College of Radiology Breast Imaging-Reporting and Data System; US-VAE, ultrasound-guided vacuum-assisted excision; PT, phyllodes tumor.

Figure 6

Pathway proposed for managing lesions suspected of benign PT or diagnosed as cellular fibroepithelial lesions or benign PT in CNB/VAB. Complete US-VAE resection: absence of residual imaging findings and palpable mass after a successful procedure. Incomplete US-VAE resection: residual imaging findings or palpable mass or even an unsuccessful procedure. PT, phyllodes tumor; CNB/VAB, core needle biopsy/vacuum-assisted biopsy; US-VAE, ultrasound-guided vacuum-assisted excision.