Vascular Complications following Vacuum-Assisted Breast Biopsy (VABB): A Case Report and Review of the Literature

Round 1

Reviewer 1 Report

Dear Authors,

In this paper, you reported a rare complication of VABB that is very interesting because despite its rarity, it should be considered to ensure proper management and early treatment when it occurs. Furthermore, you provided a review of the literature.

Nevertheless, the paper is not well written, it is chaotic and needs many improvements to be considered for publication and the review of the literature lacks details resulting insufficient for your purpose.

Abstract: abstract needs to be completely rewritten according to the correct structure for a case report.

Introduction: the references are old and inadequate with several inaccuracies. Lines 37-51 must be better synthesized with more recent data, avoiding aspects that are irrelevant for the case report. For example, the correct age range for breast cancer screening program is highly controversial with several guidelines reported in the world. I don’t think that this aspect fits well for this kind of paper. Lines 52-62 are relevant and should be better highlighted. Lines 63-67: the cited reference is very old. There are many others recent papers discussing about the indications of VABB, such as the management of B3. Lines 68-80 are relevant, but they should be better explained. Furthermore, the cited paper is old, and this may cause a wrong evaluation of the usefulness of the technique as it is reported in the next lines.

Caser report: this section must be rewritten. The subchapters are not necessary unless they refer to the two different procedures of VABB and embolization. The case report should be rearranged, starting from clinical data (e.g., age of the patient?) to imaging procedures, then VABB, complication and treatment of the hematoma. Lines 95 to 114 are unnecessary: it is sufficient to cite the BI-RADS Atlas in the references.

Line 129: the different types of biopsy procedures should be reported in the discussion section.

Line 133: lidocaine and adrenaline? Diluted or not? Why adrenaline?

Figure 1 and 2: quality needs to be improved. If it is possible, more figures are needed in this section.

Please, clarify all the acronyms in the text the first time they are mentioned and not only at the end of the paper.

Discussion: if a review of the literature is also the purpose of the paper, the references are inadequate and old, with the greatest number of cited papers ranging from 2000 to 2015. There are many other papers that may be cited with some aspects that are not considered (different type of biopsy procedures). For example, the authors may evaluate if the haematoma could have been avoided with a different approach. Moreover, the cases reported as examples of complication are not clearly depicted and may confuse the reader. Consequently, also this section must be rewritten and better organized.

Conclusion: the protocol reported has no scientific soundness. Why is it necessary a PVC positioning for a VABB? Why do you need a monitoring time of 60 minutes for this procedure? This aspect should be discussed and motivated in the discussion.

Finally, I have an ethical concern. I don’t think that a case report may be published without the consent of the patient. Please, clarify this aspect.

The paper needs an extensive revision of the English language since there are many typos, grammatical errors and many sentences are unclear or not well written.

Given these considerations, I think that the paper should be rejected but may be reconsider after an extensive revision of the methodology and the acquisition of informed consent.

Author Response

I rewrote the abstract in the form of a case report.
I revised the introduction, including more recent literature.
I eliminated abbreviations and the BIRADS system.
I made an initial correction of the English.

I have removed the division into sub-chapters and clarified the required steps.
Line 129. I think explaining it here is less dispersive.
Unfortunately I can't provide any more images.
The patient has been informed and has given her consent provided that anonymity is respected
Given the rarity of the event, it is difficult to draw up a protocol supported by data, we have limited ourselves to providing our own and noting that more research is needed.

Thank you for your kind reply and cooperation.

Reviewer 2 Report

-The introduction should be shortened

- There are a lot of grammatical errors

- The statistical references for breast cancer can be updated to the latest (not 2012)

- There was a mention of lumpectomies with 3D ultrasound - please add a reference to this

- There is no need to describe the BIRADS 1-5.  It can be cited as a reference

- Please put a reference to Karnofsky

Author Response

I rewrote the abstract in the form of a case report.
I revised the introduction, including more recent literature.
I eliminated abbreviations and the BIRADS system.
I made an initial correction of the English.

I removed the part about the lumpectomy.
I added the reference to Karnofsky

Thank you for your kind reply and cooperation.

Reviewer 3 Report

This is an interesting report of a rare complication, that occurred after a rarely performed procedure. 

Then a short review is provided. If case reports are within the scope of this journal (I leave this at the Editor's discretion), I think it's worth to mention a similar complication of this procedure in the literature.

I have only minimal suggestions.

The word VABB should be spelled out at its first appearance

"A 60-year-old woman was called back for additional imaging by the screening prgram for suspicious microcalcifications identified in the left breast’s UOQ; tomosynthesis and ultrasound examination was performed and confirmed the microcalcifications dectected in the standard projections and initially categorized BI-RADS 3. After 6 months (short interval follow-up) cluster increased and the patient was called back for further evaluation. " In this section please provide tomosynthesis and US images.

As this is a BIRADS-3 there is no need to include information on what other BI-RADS categories are. Please focus only on the BI-RADS 3.

"c.m. flow " Please avoid abbreviations

 

Author Response

I rewrote the abstract in the form of a case report.
I revised the introduction, including more recent literature.
I eliminated abbreviations and the BIRADS system.
I made an initial correction of the English.

VABB is already spelled in the title and abstract.
Unfortunately I can't provide any more images. However, since these are calcifications, the US exam was negative and the clearest mammographic image is the one included.

Thank you for your kind reply and cooperation.

Reviewer 4 Report

Thank you for letting me review this case report. I have some comments.

Abstract. There are some duplications and the language is not flowing. Could be shortened. The abbreviation US needs to be explained.

Introduction: To long and needs to be more fluent regarding language.

Reference 8 needs to be more completely referred in the reference list. Reference 9 is described as presenting the most recent data but there are more than 400 references after 2014.

Case report: I do not think it is in the scope of a Case Report to explain the BIRAD system.

In Fig 1, is the circle really located as you wanted it?

How far from the mamillary base was tho lesion located?

I do not recognise the word somministration. Italian? 

Histopathology was negative. How did you follow this up? AS you mention, it could be related to the number of samples.

Discussion/Conclusion: Good summary of the published cases.

Initials: Is this needed? Should it be Abbreviations?

 

Author Response

I rewrote the abstract in the form of a case report.
I revised the introduction, including more recent literature.
I eliminated abbreviations and the BIRADS system.
I made an initial correction of the English.

Fig 1. The red circle is in place, do you see it dislocated?
I cannot say precisely how far it was from the mammilary base.
We saw the outcome of the tests after the evaluations in anatomic pathology.

Thank you for your kind response and cooperation.

Round 2

Reviewer 4 Report

I think the authors have answered the comments accordingly.