Correlation Analysis of Ultrasound Findings and Outcomes of Minimally Invasive Surgical Treatment of Benign Breast Masses

Aim: to assess the correlation between ultrasound findings and outcomes of minimally invasive surgical treatment in patients with benign breast masses.

Materials and Methods. The study included 61 patients with benign breast masses treated by vacuum-assisted excision (VAE) with complete lesion removal. A total of 70 breasts underwent intervention, with 105 masses excised. The patients ranged in age from 20 to 75 years (mean age, 38.7 years). All patients underwent multiparametric breast ultrasonography before surgery and at long-term follow-up, at least 6 months after the procedure. At the same postoperative time points, patients completed a questionnaire assessing their subjective well-being and satisfaction with the treatment outcome.  The preoperative and follow-up ultrasound findings were compared with the questionnaire data and subjected to statistical analysis.

Results. According to the ultrasound  BI-RADS classification, with the highest category assigned to each breast, the distribution was as follows: category II – 2 breasts; category III – 60 breasts; and category IVa – 8 breasts. Concordance between the ultrasound findings and histopathological results was observed in 56 of the operated breasts (80%). A hematoma was detected by ultrasound on the first postoperative day in 5 patients, involving 1 breast in each case (7.1% of the 70 operated breasts). Residual lesion tissue more than 6 months after surgery was detected in 13 patients, corresponding to 12.3% of the 105 excised masses. Thus, complete excision at 6-month follow-up was confirmed by ultrasound in 87.5% of the removed masses.  Scar tissue was identified in the surgical bed of 36 of the 105 excised breast lesions (34.5%). The dimensions of the scar tissue ranged from 5 x 4 mm to 22 x 13 mm, with a mean size of 12.2 ± 5.0 mm. No scar tissue formation was observed in 75.5% of the VAE sites. In the questionnaire assessment, a high level of satisfaction with the outcome of minimally invasive VAE of a benign breast lesions was reported for 57 of the 70 operated breasts (81%).  When patients with and without postoperative hematoma were compared, statistically significant differences were found only in the maximal lesion diameter.

Comparative analysis according to the presence or absence of residual lesion tissue revealed statistically significant differences in two parameters: scar size and maximal lesion diameter. Neither the number of operated breasts nor the distribution of lesions according to BI-RADS category on ultrasound was significantly associated with the presence of residual lesion tissue.

Conclusions. Correlation analysis demonstrated that the most significant associations were observed among parameters characterizing the extent of the intervention and the severity of postoperative changes.

The strongest inverse correlations with questionnaire-based measures of patient satisfaction were observed for hematoma size, the number of excised neoplasms, and the maximal lesion diameter.

Scar size was not significantly correlated with individual questionnaire items or the overall questionnaire score. This finding was presumably attributable both to the relatively low frequency of scar tissue formation and to the small size of the scars following minimally invasive intervention (mean, 12.2 ± 5.0 mm).

VAE is not associated with the formation of substantial postoperative breast scarring and, consequently, does not appear to adversely affect patients’ self-reported well-being during the postoperative period.

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