Using ‘Vacuum’ technology could spare thousands of patients from major breast surgery
The larger tissue samples obtained with VAB offered greater confidence to reliably predict patients who had successfully responded to chemotherapy with no remaining disease.
08 October 2020
The use of ‘vacuum’ power to identify if there is any residual breast cancer left after chemotherapy could spare thousands of patients major surgery in the future according to research led at The Royal Marsden NHS Foundation Trust and published this week in JAMA Surgery publication.
After undergoing chemotherapy for breast cancer, patients would usually have an imaging scan i.e. mammogram / ultrasound or MRI, to assess their response to treatment. This is then followed by surgery to remove any areas still affected by cancer.
However previous studies have suggested that these imaging techniques may not precisely reflect where residual disease remains, specifically where it might be small or even non-existent. Surgeons looked to combine vacuum assisted biopsy (VAB) with existing imaging techniques, to investigate whether it could provide a more comprehensive picture of the breast, and so help them to plan the procedure more accurately.
VAB technology acts in a similar way to a standard biopsy; patients are given local anaesthetic before radiologists use a larger than average needle to take a sample. Unlike normal needles, VAB is attached to a tube that applies a vacuum to extract breast tissue. Clinicians can take more tissue but with a minimally invasive technique. The samples are then sent off to the lab for analysis.
Researchers at The Royal Marsden, The University of Texas MD Anderson Cancer Center, and Seoul National University Hospital analysed results from 166 patients who had a biopsy following chemotherapy. 143 underwent VAB and 23 had core cut biopsy, another method of image-guided biopsies.
What is particularly exciting is the potential for this technique to accurately pinpoint patients who have completely responded to chemotherapy with no remaining disease.
Lead author Mr Marios Tasoulis, Locum Consultant Oncoplastic Breast Surgeon at The Royal Marsden, explained they found that a standardised breast assessment protocol using VAB was significantly accurate at identifying residual cancer. The larger tissue samples obtained with VAB offered greater confidence to reliably predict patients who had successfully responded to chemotherapy with no remaining disease.
He said: “What is particularly exciting is the potential for this technique to accurately pinpoint patients who have completely responded to chemotherapy with no remaining disease. Often when we get to theatre after a patient has finished chemotherapy, we remove tissue only to confirm there is no cancer left. If there is a way to avoid this it means many thousands of patients could be spared a general anaesthetic, surgery and additional worry. However, more research is required to assess the safety of omission of surgery in these exceptional responders. For those patients who do have residual disease, VAB appears to be a much more accurate method to establish if and where cancer might remain, offering patients a much more personalised and accurate treatment plan.
“We hope that in the future this could prevent thousands of patients whose cancer has completely eradicated by chemotherapy from undergoing unnecessary lumpectomies or mastectomies.”