Evaluation of the Effectiveness of Laser Interstitial Coagulation in Ultrasound-Guided Vacuum-Assisted Aspiration Resection of Breast Neoplasms

The increasing incidence of both benign and malignant breast pathology, along with advancements and the active implementation of high-tech surgical techniques, has led to a rise in the number of vacuum-assisted biopsies (VAB) performed. In addition to the growing number of VAB procedures, there is a trend toward expanding the method’s capabilities—from performing biopsies for diagnostic purposes to the complete removal of lesions for therapeutic purposes as an alternative to traditional segmental resection.  There are numerous variations of total VAB, but in most cases, it involves the removal of a single small lesion in one breast, as the limiting factors include the risk of intraoperative bleeding and incomplete tumor tissue removal. Therefore, key issues in the field of interventional minimally invasive breast surgery today include the development of an adequate intraoperative hemostasis technique aimed at preventing complications, expanding VAB capabilities for the removal of larger and multiple lesions, and defining ultrasound criteria for its effectiveness and adequacy in real-time navigation. 

The article presents an analysis of VAB procedures performed for the removal of single and multiple breast lesions in 986 patients, including simultaneous excision of multiple lesions in both breasts, with and without the use of laser interstitial coagulation (LIC). The methodology of LIC under real-time ultrasound guidance is described, along with ultrasound criteria for assessing its effectiveness and adequacy.

Objective:  To evaluate the effectiveness of laser interstitial coagulation (LIC) during ultrasound-guided vacuum-assisted biopsy (VAB)  in patients with breast masses. 

Materials and Methods:  From 2017 to 2024, a total of 986 patients underwent ultrasound-guided VAB in the day hospital of the B.V. Petrovsky Russian Research Surgery Center, SCC №2. A total of 1,433 breast lesions were removed, with the number of excised lesions per patient ranging from 1 to 7. The maximum lesion size removed was 54 mm.  Indications for intervention were determined based on instrumental diagnostic methods (stratified according to the BI-RADS scale), as well as patient history, symptoms, and laboratory findings. Before therapeutic VAB, all patients underwent preoperative morphological verification. While in the process of developing an effective intraoperative hemostasis technique, VAB was performed without LIC in 275 patients. In 711 patients, VAB was performed with LIC as a prevention against hemorrhagic complications.

Results:  The use of LIC significantly expands the capabilities of vacuum-assisted biopsy (VAB) for the removal of multiple and/or large breast lesions. The overall rate of hemorrhagic complications in the VAB group without LIC was 4.36%, whereas in the LIC-assisted VAB group, it decreased to 1.97%. The residual tissue rate in the VAB group without LIC reached 16%, while in the LIC-assisted group, it was reduced to 6.89%.  When adhering to the described ultrasound navigation technique and adequacy control of LIC, VAB serves as an alternative to “open” breast surgeries. LIC enhances the safety of VAB by minimizing the incidence of hemorrhagic complications, expanding its capabilities, reducing the risk of residual tissue, and promoting the formation of a finer scar.  According to univariate regression analysis, significant factors influencing hematoma development included lesion length, the number of lesions, lesion multiplicity, and LIC application. Multivariate analysis identified lesion length and the number of excised lesions as independent factors associated with an increased risk of postoperative hematomas, while the use of LIC was associated with a 2.47-fold reduction in hematoma risk.

Conclusion: LIC is an independent factor that significantly reduces the incidence of hemorrhagic complications during therapeutic vacuum-assisted biopsy by 2.47 times. This technique enables the safe and simultaneous removal of multiple lesions, including those affecting both breasts, as well as large-sized lesions. The use of LIC reduces the required duration of subsequent elastic breast compression from 24 to 6 hours and  the risk of residual tumor tissue, and minimizes scar formation in the tumor bed.

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