FEATURES OF PREOPERATIVE MARKING AND NAVIGATION DURING VACUUM

ASPIRATION BIOPSY OF BREAST MASSES UNDER THE ULTRASOUND CONTROL

 

Maruchak E.A.^1,2, Levanow A.V.¹, Zubareva E.A.², Gorsky V.A.^1,2, Glushkov P.S.¹

 

1 - Petrovsky National Research Centre of Surgery.

2 - Pirogov Russian National Research Medical University. Moscow, Russia.

T

he increase in the incidence of breast cancer (BC), as well as the development and widespread introduction of new minimally invasive diagnostic and therapeutic technologies into surgical practice has led to attempts to more widely explorations of the possibilities of vacuum aspiration biopsy (VAB). Some authors have proposed many different options for performing VAB, however, currently relevant issues in this area of interventional minimally invasive mammology are the development of a methodology for preoperative marking and ultrasound navigation aimed at expanding the capabilities and improving the effectiveness and safety of the technique.

Purpose. Development of a technique for preoperative marking and intraoperative navigation under the ultrasound control in case of VAB breast neoplasms.

Materials and methods. The article presents the experience of performing more than 1600 VAB for diagnostic and therapeutic purposes, performed in 882 patients with single and multiple breast masses under the supervision of ultrasound examination. Indications for interventions were determined by an oncologist based on the results of instrumental diagnostic methods with cancer risk stratification according to the Breast Imaging Reporting and Data System (BI-RADS) scale, as well as anamnesis, complaints and laboratory data. All patients underwent morphological verification (fine needle aspiration biopsy or core-biopsy) of the tumors to be removed before the VAB for therapeutic purposes at the preoperative stage, and on the day of surgery, marking of the insertion points of a robotic needle probe according to the proposed scheme.

Results. The article describes in detail and illustrates with drawings and echograms the technique of preoperative marking of the insertion points of a robotic needle probe for the removal of single and multiple breast tumors. The algorithm and technical features of intraoperative ultrasound navigation at all stages of the VAB are described, aimed at preventing complications and expanding the capabilities of the technique. Ultrasonic criteria of anesthesia technique, control of insertion and stroke of a robotic needle, hemostasis using laser interstitial coagulation are presented. The number of simultaneously removed formations in patients ranged from 1 to 8 in one breast. The size of the formations reached 56 mm.

Discussion. A fundamentally important point for the successful implementation of the VAB is to determine the optimal insertion points of a robotic needle probe, which allows resection of several neoplasms from a single puncture. In addition to real-time ultrasound monitoring; intraoperative navigation is facilitated by the presence of a cutaneous mark in the area of the removed mass. Local anesthesia, in addition to the main task, plays the role of hydropreparation, makes the stage of insertion of a robotic needle safe and serves as a prevention of injury to the skin and muscles. An effective way to prevent hemorrhagic complications is to perform laser interstitial coagulation. Compliance with the principles of marking the optimal insertion points of the robotic needle, as well as ultrasound navigation during the implementation of the VAB, allowed to avoid such complications as skin injury, muscle injury, perforation of the chest wall, wound suppuration and also minimize hemorrhagic complications. Residual mass tissue after VAB resection was found in 12 patients (1,3% or 0,75% of the number of tumors removed).

Conclusion. If the preoperative marking of the entry points of the robotic needle and the principles of ultrasound navigation are followed, the VAB is an alternative to "open" surgical interventions on the breast. Ultrasound examination is an affordable, simple and highly informative imaging method at all stages of the VAB. Ultrasound allows to monitor anesthesia, insertion of a robotic needle, the resection process itself, the adequacy of haemostasis, as well as an assessment of the resection zone for complete removal of neoplasm tissue.

 

Keywords: needle aspiration biopsy, breast, ultrasound diagnostic, VAB, vacuum aspiration biopsy, BI-RADS, fibroadenoma, breast cancer, ultrasound navigation, marking, intracurrent papilloma.

 

Corresponding author: Maruchak E.A., е-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Maruchak E.A., Levanow A.V., Zubareva E.A., Gorsky V.A., Glushkov P.S. Features of preoperative marking and navigation during vacuum aspiration biopsy of breast masses under the ultrasound control. REJR 2024; 14(2):43-56. DOI: 10.21569/2222-7415-2024-14-2-43-56.

Received: 20.06.24 Accepted: 05.07.24