AUTHOR=Couto Henrique Lima , Valadares Carolina Nazareth , Soares Aleida Nazareth , Ricardo Bernardo Ferreira de Paula , Toppa Paola Hartung , Coelho Bertha Andrade , Pessoa Eduardo Carvalho , Resende Vivian , Ferreira Tereza Cristina de Oliveira , Mattar Andre , Amorim Andressa , Clarke Paula , Freitas-Junior Rufo , Silva Junior Gabriel de Almeida , Sharma Nisha , Bartels Henrique Silva , de Paula Charles Andreé Joseph , Cunha Júnior Geraldo Felício , Oliveira Dênia Reis de Paula , Silvestre da Silva Bruna Torres , Siqueira Daniela Rodrigues , Castilho Marcus Simões , Antonini Marcelo , de Amorim Heverton Leal Ernesto , de Oliveira Jane Sanglard , Pires Bruna Antunes de Miranda , Pires Douglas de Miranda , Ferreira Shirley das Graças , Moraes Thais Paiva , Oliveira Larissa Barbosa , Soares Paula Martins Cristina , de Oliveira Vilmar Marques , dos Santos Annamaria Massaud Rodrigues , Rahal Rosemar Macedo Souza , Hassan Augusto Tufi , de Lucena Clécio Ênio Murta , Tosello Giuliano , Buttros Daniel de Araújo Brito , Novita Guilherme , Saliba Romana Giordana Ribeiro , Carvalho Bárbara Pace Silva Assis , de Almeida Junior Waldeir José , Ramos Marcellus do Nascimento Moreira , Mendonça Ana Carolina Guglielmelli , Reis Fernando Marcos 

TITLE=Vacuum-assisted biopsy in the era of low-risk ductal carcinoma in situ active monitoring: real world data and implications

JOURNAL=Frontiers in Oncology

VOLUME=Volume 15 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2025.1618476

DOI=10.3389/fonc.2025.1618476

ISSN=2234-943X

ABSTRACT=BackgroundThe short-term oncological safe of active monitoring for ductal carcinoma in situ (DCIS) with low risk (LR-DCIS) of progression to invasive cancers (IC) has been demonstrated. This study evaluates vacuum assisted biopsy (VAB) as diagnostic test for LR-DCIS active monitoring (AM) in real-world clinical practice.MethodsDatabase analysis of 116 cancers [both invasive breast cancers (IC) and ductal carcinoma in situ (DCIS)] diagnosed by VAB submitted to standard surgical treatment with complete histological data from VAB and surgery from 04/13/2017 to 11/28/2020. The VAB results matched the surgical pathology, considered the gold standard, and AM criteria. The pathological diagnoses were grouped into malignancies requiring guideline surgical treatment [DCIS with high risk (HR-DCIS) of progression to IC or IC] versus those eligible to alternative AM (LR-DCIS). HR-DCIS/IC were considered positive while LR-DCIS negative results. VAB sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were obtained.ResultsMean age 55.6 [± 12.27]; mean IC size 7.14 [± 5.17]mm and 12.6 [± 11.63]mm for DCIS. Out of 116 malignancies diagnosed by VAB, 15 (12.9%) resulted LR-DCIS in the biopsy, 10 (8.6%) confirmed LR-DCIS in surgery, and 5 (4.3%) upgraded to HR-DCIS/IC in surgery. VAB showed 95.28% (89.3–98.5; 95% CI) sensitivity, 100% (69.2–100; 95% CI) specificity, PPV was 100% (96.4–100; 95% CI), and NPV 66.67% (38.4–88.2; 95% CI). VAB LR-DCIS AM was 6.9% (8/116) and underdiagnoses 2.6% (2 pT1a-bN0 hormone receptor positive and 1 HR-DCIS).ConclusionVAB LR-DCIS AM would lead to a moderate (6.9%) overall reduction of short-term breast cancer surgical overtreatment counterbalanced by a low rate (2.6%) of underdiagnosed HR-DCIS/IC potentially treatable by adjuvant hormone therapy.Clinical Trial Registrationhttps://plataformabrasil.saude.gov.br/visao/pesquisador/gerirPesquisa/gerirPesquisaAgrupador.jsf, identifier 25761019.8.0000.5138.