| Background and objective:Lesions of the breast are extremely common in females,most of them are benign.The general treatment for the benign breast lesions is local excision which may remain obvious scar on the skin and is difficult to resect some impalpable or deep lesions.So finding out a minimally invasive treatment becomes a focus.Vacuum-assisted breast biopsy(VABB) has been gradually applied in the minimally invasive treatment of benign breast lesions.Vacora is a kind of VABB,which was licensed to be used in 2005 in China. The objective of this research is to evaluate the application of minimally invasive Vacora vacuum assisted biopsy system in the diagnosis and treatment of benign breast lesions under ultrasound guided.Methods:135 female patients with 207 lesions underwent Vacora minimally invasive resection under the guidance of ultrasound from April to October,2008. The average age is 38±11 years.The breast lesions were mainly screened by ultrasonography and core needle biopsy(CNB).Firstly,the location,size,shape, edge,orientation,internal echo pattern,posterior acoustic features and calcifications were observed by 2- dimensional ultrasonography.Then the lesions were further observed with color Doppler flow imaging(CDFI) and Pulse-wave Doppler(PWD).The pattern,distribution,number,character,the peak systolic velocity(PSV) and resistance index(RI) of the internal and peripheral vessels of the lesion were examined.According to breast imaging reporting and data system (BIRADS) recommended by American College of Radiology(ACR),we classified all masses into two groups:1.The lesions of BIRADS2-3 were sorted into treatment group directly.2.The lesions of BIRADS4 would firstly perform CNB with the patient's consent.If the pathologic diagnosis was benign and the patient wanted to select the Vacora minimally invasive resection,the lesions would be sorted into treatment group too,otherwise other ways would be recommended.All lesions underwent ultrasonography guided Vacora biopsy and resection.The pathologic diagnosis was made in all cases.All the patients would have been followed up in half a year;the therapeutic effect and complication were observed.Results:1.202 BIRADS2-3 and 5 BIRADS4 lesions were diagnosed by ultrasonography before the operation,the latter were done CNB and the pathologic diagnosis was benign.All of the 207 lesions underwent ultrasonography guided Vacora biopsy and resection.198 lesions were pathologically diagnosed as benign,8 lesions were as benign combining atypical hyperplasia,and another one was benign combining intraductal carcinoma.2.The whole operation was performed under the guidance of ultrasound.The ultrasonography had many advantages in preoperative localization and the display of the lesion,the biopsy needle and the hemorrhage during the operation.At times some acoustical artifact,such as posterior acoustic shadow of the needle,gas echo, can be seen during the operation.3.Among the 135 patients,83 patients underwent the resection of single lesion at one side by an operation.29 patients underwent the resection of multi-lesions at one side by an operation.12 patients underwent the resection of single lesion at every side by an operation.6 patients underwent the resection of single lesion at one side and multi-lesions at the other side by an operation.4 patients underwent the resection of single lesion or multi-lesions at every side single lesion by two times operation.1 patient underwent the resection of multi-lesions at every side by three times operation.5 lesions were resected through one tunnel.4.All lesions were biopsied and resected by 10-gauge probe.Depend on the maximal diameter(D) of the lesions;they were divided into four groups.The mean number of times and operation time:group 1(D≤1cm,n=83) took 5±2 times and 17.6±9.5min,group 2(1cm≤D＜2cm,n=98) took 13±7 times and 26.2±12.0 min,group 3(2cm≤D＜3cm,n=19) took 36±20 times and 50.8±18.7 min,group 4(D≥3cm,n=3) took 90±18 times and 87.7±15.7 min,the above indexes had the significant difference among the groups(P＜0.01).5.Pain during operation was reported in 11 cases,3 patients had severe pain and were appended anesthetic again.Hemorrhage was reported in 4 cases,3 of which were sequentially underwent the operation after pressor haemostasis,the other one chose another day to complete the treatment.All the patients were rechecked after 24-48h pressor binding,Local hematoma were found in 23 cases and skin ecchymosis were found in 5 cases,all of them disappeared after 3-6 months follow-up.3 patients was found residual lesion at the original location.2 of them underwent the second operation;the other one chose the local excision.There wasn't any severe complication in the cases,such as drug allergy;infection, pneumothorax.Conclusions:1.BIRADS level judged by ultrasonography is convenient to select suitable lesions.The well operation guide line can be selected by ultrasonography according to the location and number of lesions.The postoperative recheck of ultrasonography needs to be done,which is important to observe complication and therapeutic effect.2.The ultrasonography comparison during the operation is help to reduce residual lesion.Because of the operation way and the principle of the ultrasonography,some special sonogram,such as posterior acoustic shadow of the needle,gas echo,can be seen during the operation.3.The number of resection and the time of operation are closely correlated with the size of lesion,sometimes:they also are influenced by the operator's skill, the location of needle,the direction of resection,the patient's pain and the hemorrhage during the operation.4.The property and location of lesions and the selection of the operation tunnel are the important influenced factor of multi-lesions resection.5.Vacora vacuum assisted biopsy system has the advantage of small volume, internal battery,and convenient to carry.The ultrasonography guided Vacora minimally invasive biopsy and resection is an ideal method for the treatment of benign breast lesions.
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