Chapters Transcript Video Series Title: Contemporary Perspectives in Breast Biopsy and B3 Lesions. Episode 1 Title: Beyond the Core Advances in Vacuum Assisted Breast Biopsy Beyond the Textbook brought to you by the advanced clinical education and training team at BD. Follow and subscribe wherever you get your podcast to stay up to date with the latest expert conversations in clinical practice. This podcast is on behalf of Becton Dickinson and Company. The opinions and techniques presented herein are for informational purposes only, and the decision of which technique to use in a particular interventional application should be made by the physician based on the individual facts and circumstances of the patient and previous medical experience. The participating healthcare professionals have been compensated by Becton Dickinson and company to participate in this podcast. Welcome to BD Advance Beyond the Textbook, the podcast where we explore real world clinical insights that go beyond guidelines to improve patient care. Today's episode, Beyond the Core Advances in vacuum assisted breast biopsy is episode one of our 3 episode series Contemporary Perspectives in Breast Biopsy and B3 Lesions and features Doctor Shakiri as our moderator and guest Doctor Sharma. This series is designed to inform and engage physicians, advanced practice providers, and radiology technologists on the evolving landscape of breast diagnostics and minimally invasive care. Through these expert discussions, we aim to demonstrate how these technologies are reshaping the management of breast lesions, particularly B3 lesions, by providing effective, minimally invasive alternatives to traditional surgical approaches. It is our pleasure to introduce Doctor Shakiri and Doctor Sharma. Hello and welcome to the BD Advanced Clinical Education and Training podcast, Beyond the Core Advances in vacuum-assisted breast biopsy and vacuum-assisted excision. I'm Shadi Aminololamashikeri. I'm professor of radiology and the chief of the division of breast Radiology in the Department of Radiology at University of California, Davis in Sacramento, California. And I'm the moderator for this discussion. I'm joined by Doctor Nisha Sharma, a consultant radiologist and director of the breast screening program for Leeds and Wakefield in the UK. Doctor Sharma is an internationally recognized expert in breast cancer screening, breast radiology, and AI in breast screening. Welcome, Doctor Sharma. To this discussion. Uh, now, I have had the great pleasure of actually listening to Doctor Sharma speak at multiple different, uh, conferences, international conferences, and I'm just always amazed when I hear the story of the evolution of how her group and practice with colleagues, uh, Started to use vacuum assisted breast biopsies and vacuum assisted excision for B3 lesions. I do have to add for US audiences that B3 lesions does not refer to BIRAD's 3 lesions, but I will let Doctor Sharma explain that as she, uh, uh, starts giving us the story of the evolution of, uh, in her practice. Doctor Sharma. Yes sir. Shakiri for the kind introduction and I'm absolutely delighted to be here. So vacuum assisted breast biopsy, if we think about it, was actually available in the early 2000s. And in the UK many of the breast units had actually purchased a vacuum assisted breast biopsy device. But when you think about it, when we first started in breast imaging in the 1980s, we were using fine needle aspiration. And then we moved to needle core biopsy because we knew we were getting better sampling. But we still knew that there were challenges related to needle core biopsy, particularly when we were performing X-ray guided procedures. And vacuum assisted breast biopsy was developed to overcome that problem. But when we saw the needles. We got scared. We saw the size of the needles, the volume of tissue, and we felt um anxious and as a result, people bought the device and it was put into a cupboard. Then what happened was, as people began to recognize that maybe needle core biopsy under X-ray guidance isn't giving us the answer, people started looking at vacuum assisted breast biopsy. And we were dealing with the smaller needles, so we were dealing with the 10 gauge needle and um and we also had at that time 14 gauge vacuum assisted breast biopsy needles. And people started then thinking, well, we need to work with this. And what we created in the UK was an educational program. Where we had different units that had the breast biopsy device and we got together as a group. So it was almost like a peer educator group and support group, and people started using the device and they liked the data that they were getting in terms of biopsy results, and there was a reduction in the number of women needing repeat biopsies. Because often we would get a definitive result and when we were doing X-ray guided biopsies in those days, we were really going for calcifications and we were getting representative calcifications. So the community performing vacuum assisted biopsy grew steadily and we grew in confidence. But what was really important was the communication between all the consultants and the fact that we could provide that peer support. And really that's what made vacuum assisted biopsy the device that we started using at the beginning of the um the second decade. So in 2010 onwards, Well, I have um listened to you talk about the, um, the, the evolution of the use of vacuum-assisted excision. And here, I'll just say for our audience that when, if I refer to vacuum-assisted biopsy, I might say VAB and if I say uh VAE I'm referring to vacuum-assisted excision. So, I uh have listened to you talk about how vacuum-assisted excision came to use in your practice. Um, as a, uh, replacement for traditional surgical excision of B3 lesions, and I find that fascinating. Would you tell us the story of how this came about in your practice? Yes, so, um, I became director of the breast screening program in my hospital in 2008. And one of the challenges that we had, um, in those days was when you diagnosed a B3 lesion. So that's following a core biopsy, histologically they said we have a lesion that we either call high risk or B3. And we always sent these women for surgery because we needed more tissue, more sampling to make sure we weren't missing a coexistent cancer. So my surgeon, the lead surgeon, said to me, Nisha, we have too many women going to surgery and they still end up not having cancer. And so we're not meeting the target that has been set nationally by the National Breast Screening Program. So you need to find a solution. And I was newly appointed and he said, so that is your first job. So, um, so I went away and I was thinking about how do I solve this problem. And I was using vacuum assisted breast biopsy when doing X-ray guided procedures and I was also using it in the ultrasound setting. And I thought to myself, well, actually we're taking more samples, we're getting more tissue. Could we use that to see if we could stop women from going to surgery? So I created a protocol where I had recommended that once we'd done a core biopsy and we had a B3 lesion, we would then go on to do vacuum assisted excision where we would obtain more tissue and therefore representative sampling. And we would then, if we didn't identify cancer, because if we identified cancer they'd go on to have treatment. But if it remained B3 or benign. And there was no radiological or pathological concern, could we just put them through to follow up for 5 years with mammographic follow-up? So when I set the guidelines and the protocol, I spoke to my radiology colleagues first. And my radiology colleagues were keen to support this. And most of our vacuum assisted breast biopsies were X-ray guided. So then I went to the surgeons. And uh the surgeon said we will support any endeavor that stops us taking these women to theater. So we're happy to try and see if this protocol will work. And then we spoke with our pathologists, and our pathologists again, they were slightly anxious because they're used to the lesion being excised whole, um, and this time recognized that they would get samples that were piecemeal, um, but again, were receptive because they recognized that women going for surgery for benign lesions wasn't ideal. So from that perspective, what was really important was that we had to engage the full multidisciplinary team. We had to make sure that we had the surgeons on board, we had the pathologists on board and the radiologists. Because together if we agreed on the protocol, then we would deliver the protocol as a team. And we could then audit the work that we were doing to see if this was making a difference for our patients. And alongside that, we were also doing patient satisfaction surveys to make sure that the patients were happy with having a vacuum assisted breast biopsy and a vacuum assisted excision in for managing the, the B3 lesions. So we set up the service 1st of April 2009 in our hospital. And um we gathered the data and we presented the data at our local audit and then at national audits. Um, and this was gaining momentum. But more importantly, um, after the first year of implementation, we were now meeting the target for the benign biopsy rate. So we were no longer outliers in terms of performance. And uh my surgical colleagues were absolutely delighted. And what was important for them was that they were spending more time now treating patients with cancer. Or requiring complex surgery rather than dealing with women who had benign lesions. Wow, what a great example of using an innovative method to uh work collaboratively and make things better for patients and improve workflows, uh, really amazing. Can you talk a little bit about what the current status is for vacuum assisted excision in the UK or any insights you might have on adoption of it in other countries? So, um, so following our, um, audit and publications, um, what was really a pivotal point for the UK was 2012 where the Marmot Review was published, and this was a review looking at the role of breast screening because at that time there was a lot of national press centered around the criticisms of breast screening. And um this wasn't only happening in the UK but this was happening in Europe and in the States. And uh so this independent review fortunately showed that breast screening saves lives. But one of the areas that they concentrated on was over diagnosis and overtreatment. Now overdiagnosis was in the context of diagnosing a good prognostic cancer that may not have presented itself if a woman hadn't attended for screening. So that's what they meant by overdiagnosis. And if you're old enough to remember, the term overdiagnosis meant that radiologists were being blamed everywhere for the cause of overdiagnosis. But then they realized that actually we couldn't distinguish good prognostic from poor prognostic cancers on mammography, and they recognized actually what we had control of was overtreatment. So therefore, following the Marmot review and following the publications and data we had presented, the National Breast Screening Program decided to develop guidelines on how to manage B3 lesions within the National Breast Screening Program. And we had 2 radiologists, 3 pathologists, and 3 surgeons involved in the writing group, and I was one of the radiologists. And it was really important because it gave us a better understanding about the, the B3 lesions. And what was key was why would we send a woman to surgery rather than offer vacuum assisted breast biopsy. And there were 3 groups where the pathologists felt really strongly that surgery was still first line. And that was papillomas with atypia, spindle cell lesions, and fibroepithelial lesions. But what they said was that all other types of B3 lesions could be managed with vacuum assisted excision in terms of providing further sampling to be able to confirm that we're still dealing with a benign lesion or be able to upgrade to non-invasive or invasive cancer. So we then um adopted the guidelines for managing B3 lesions within the national breast screening program in 2016. And the guidelines were published in 2018. And then we presented data following implementation. That showed that just under 70% of women were avoiding surgery altogether. Which again highlighted how important this innovative pathway was in terms of creating a patient centered pathway that was still diagnosing cancers appropriately but reducing overtreatment. And stopping women from having surgery unnecessarily. And this created a movement um where we then created key performance indicators. So every breast screening unit was being monitored to see if they had adopted the guidelines. And if they didn't adopt the guidelines, they had to explain why. And if one of the factors was a lack of accessibility to vacuum assisted breast biopsy or excision, often patient advocates would say, well why is that the case? And they would ask the individual trust to invest in the equipment so that patients had choice. And therefore creating an equity in terms of care and not a postcode lottery. So from a UK perspective, what this meant was that we were now treating our V3 lesions with vacuum assisted excision, with only a handful of cases going to surgery. Multidisciplinary discussion for each of the lesions was really, really important to make sure that we didn't have radiological or pathological discordance, and we always did the right thing by our patients. So we have a wealth of data showing that this was safe. And then in 2024, we had a further publication that was looking at um B3 lesions with atypia. So these are your atypical ductal hyperplasias, lobular neoplasias, and flat epithelial atypia. And this publication looked at B3 data collection from 2003 all the way to 2012. And they looked at the subsequent cancers that developed once you had been diagnosed with a B3 lesion with atypia. Because one of the challenges we had was we were doing annual mammographic follow-up for B3 lesions with atypia and then they were going back into the routine screening program if they were of screening age. And this paper showed that the cancers they develop are very similar to screen detected cancers. And actually, annual mammographic follow-up was not necessary. So you could actually put women back to routine screening. And be able to then detect their cancers if they were going to develop them because they were at increased risk of developing breast cancer. And more importantly, what it showed was that women who were being treated with vacuum assisted excision did not have underdiagnosed cancers. So this has led to a new change in practice because we updated our assessment guidance and now all women with B3 lesions, treated with vacuum assisted excision or even if they have to go for surgery. are now being followed up through the breast screening program and no longer have to attend annual visits to the hospital to have their mammogram. Wow. Well, I, I know that this work, your work with colleagues really set up a, um, a wave of um thinking about our processes elsewhere in the world and how we're dealing with high-risk lesions, B3 lesions. Um, and, but we're, we're definitely behind, I'll say, as we're coming up with, uh, consensus agreements between societies, professional societies, and how we deal with these lesions. Um, would you like to, um, add anything about what you know about any global guidelines that currently talk about using, um, vacuum assisted biopsies and vacuum assisted excision for B3 lesion management? Um, and maybe touch on any regional differences that you think are important. Well, yeah, so I mean, what, what's great is that with the work that we've done in the UK this sort of filtered through into Europe. So Europe developed international consensus guidelines on how to manage B3 lesions, and they're now on their 3rd version. And essentially they agree with the UK guidelines, but where the challenge is, is that atypical ductal hyperplasia, as we know, is one of the B3 lesions with atyia that will be upgraded to cancer more often than not. And um so they still felt surgery was necessary for ADH. But they agreed that with B3 lesions without T-tipia, you could consider vacuum assisted excision. I was then involved in uh writing the EOMA guidelines um where they again created a group of individuals from UK and Europe. So we had radiologists, surgeons, pathologists and um radiologists and patient advocates. And I thought that was really interesting and important. So when we developed the EOMA guidelines, the EOMA guidelines um actually we're going to say surgery for ADH so atypical ductal hyperplasia. But I then said, well, in the UK we offer vacuum assisted excision, we've got the evidence to show that we're not creating harm, we're still detecting the cancers and really we need to be able to offer alternatives because surgery is what we have been doing for the last 3 to 4 decades. And surely as technology has advanced, pathology has advanced, we should be able to advance in the techniques that we can offer women. And um and the patient advocates actually then said well if we have a choice. Of what we could have, I think that's really important. And also what it meant because we didn't want to create an equity. So if you had a hospital that didn't have access to vacuum, biopsy. Then the only thing they could offer was surgery. But if you had a unit that did have the vacuum assisted biopsy device, then they could offer vacuum assisted excision. So actually, the guidelines were enabling hospitals within Europe to now offer this service for managing B3 lesions. And for me, that was a really important step. So the EOMA guidelines were published. And what's what I have found amazing is I go to the European Congress of Radiology and I tend to go every year. And um when I went pre 2020. There was very little on the role of vacuum assisted excision to manage B3 lesions. It was mainly surgery. And now when I go to the European Congress of Radiology, All the abstracts are about the role of vacuum assisted excision for managing B3 lesions. And that makes me really proud to be able to see that transition. And it's taken time, but actually we're creating a patient centered pathway. And um so I feel that the guidelines, and I think that's something we have to remember when we develop guidelines, we have to develop guidelines that look at now but are also futureproof. And the other point that I'd just like to mention about guidelines are often when we look at the evidence, the evidence is historical and it often supports historical practice. Because that's where you'll have the majority of your evidence. But don't discount innovations. There will be publications. There won't be as many in number. And it may not be a randomized controlled trial because they're very expensive to run now. So at the end of the day, when you look at innovations, look at the publications and look at the potential. And don't discount them because they won't be level one evidence. So that was something that was really important when we developed the EOMA guidelines that we recognized we weren't getting level one evidence, but the evidence and the publications that were coming through were important to support this change, and the patient advocates played a really important role. Uh, yeah, I really appreciate you, uh, taking us through the scientific method by which, um, you and your colleagues developed these, uh, guidelines and protocols for making things better for our patients. Is there any, uh, um, clinical research that supports, um, vacuum-assisted excision that you would like to highlight for our audience? So I mean I've, I've talked about the um the Sloan paper that was published um in 2024 that looked at data and subsequent upgrades following either surgery or vacuum assisted incision. And what that paper showed which was really interesting is that the type of B3 lesions that we're identifying now are not as aggressive as they used to be back in the early 2000s. And the reason for that is, if you think about it, when we were started screening, we were using analog. We then moved to digital mammography and now we've got homosynthesis. So our image resolution is much, much better. And because our image resolution is much, much better, we're picking up smaller clusters of calcifications. And because our biopsy techniques are much better, we're able to biopsy them. So actually what they've said is that the B3 lesions we're picking up now are more risk factors for developing cancer in the future rather than being related to coexisting cancer that we've just missed through our biopsy technique. So I think again what we've got to remember with that evolution over time is that the B3 lesions that we're identifying now are very different to the historical B3 lesions we used to identify. And as a result, um, we've got to think about minimizing harm. And there have been numerous publications from the Italian groups and um from um other countries within Europe again showing the safe practice of vacuum assisted excision as an alternative surgery. So I think, I think there have been important publications and the momentum and evidence that we have gathered has shown that the meta-analysis and systematic reviews that vacuum assisted excision is a safe alternative. And then if you think about one of the challenges we have is centered around ADH. Because we know that it can be upgraded, as I said before, to non-invasive cancer predominantly, but also invasive cancer. But if you think about it, um, across the globe we have 4 trials looking at active surveillance for low grade DCIS. Mhm. So this is where you've done a biopsy and you've actually diagnosed cancer. So you've diagnosed low grade DCIS or low risk DCIS. And our surgeons don't want to do surgery. Because they feel that that is overtreatment. So we had the UK trial, we had um which was the Loris trial, we had um Lord Loretta and um and all these trials. are basically they're either using active surveillance on its own or with endocrine therapy. And what's really important is the ADH, if it's going to be upgraded, belongs to the low grade neoplasia family. So it's likely to be upgraded to low grade or low risk DCIS or it's likely to be upgraded to a grade one good prognostic cancer. So we've got ADH, which is a benign entity which if we are going to upgrade is going to belong to the low grade neoplasia family. And when we do diagnose a low grade neoplasia, many surgeons are now keen not to operate. So It, it doesn't make sense to me that we are prepared to be less aggressive with low grade DCIS. But we're being overly aggressive with ADH. And I think people are now because I think when you make changes you often have um anxiety, you're anxious about change, the impact and the data is now accruing that shows that vacuum assisted excision is safe. We have shown in the UK that if we're, if we do have ADH and we do do vacuum assisted excision, we can identify cancer. And they can then go on to have treatment or we can then just put them back to routine screening now. So ADH, we shouldn't be aggressive in the way that we manage it. And I think people are now beginning to realize that and are beginning to rethink, um, the concept and risks associated with ADH. And we're not quite there yet, so I think that's definitely work in progress, but I, I just find it really interesting how um surgeons particularly um are looking to reduce overtreatment in terms of the axilla, in terms of the breast, and that's for biopsy proven cancers. And yet, we're not thinking that ADH is a benign entity. And why are we being so aggressive? So, um, but again, I recognize that change takes time and um and as more publications come to fruition and people gain um confidence and expertise in their own data and their own performance, then I think that will only be a matter of time. Wonderful. And I, I think, uh, you know, as we do this, it's so important for each one of us with advancing technologies to be paying attention to our practices and auditing our clinical practice, and working with our surgeon colleagues, our pathologist colleagues to make sure that we understand within our own locality, um, what we're doing, what our techniques are, and, um, how we can make things better. So, for those physicians that might be interested in bringing um vacuum assisted excision into their practice, Doctor Sharma, what would you say they should consider regarding training, equipment investment, um, whether their staff are ready? I know reimbursement is a different entity in across the globe, uh, maybe some patient workflows and or coordination with, um, the other disciplines. What are some of your suggestions? Yeah, so I think teamwork is really, really important. You've got to work collaboratively. A single person cannot make a change, but if you work as a team, you can make a significant change. So I think it's understanding why are you wanting to implement the change. And really, the, the real driver here should be patient-centered care. Stopping women from having surgery unnecessarily. So then um you have to look at the, the vacuum assisted biopsy device and um and training is really important. And often what you'll find is application specialists are absolutely really important for you to understand the device and how it works and operates. So often you can work with phantoms so you get an idea of the needle, get comfortable with the needle, working with the needle, understand the buttons, understand the rules, the functions. And then when you do have your first patient, always ask an application specialist to be able to join you. Now you are the clinician performing the procedure, but they're there to help you from a technical perspective. Because they will have skills and knowledge that will help you to be able to deliver good patient care. So remember it's teamwork, team effort. And again, the radiographers play an important role in that situation as well, because they have to support positioning the patient. They have to understand why that's important. The patient has to be comfortable and they need to understand what we're doing and why we're doing it. So if people are informed and engaged, then you will work together to make the procedure a success. You also need to work with the surgeons to explain to them what you're doing, what the technique involves. Invite them to come and watch a procedure, um, if they wish. And, and again, with the pathologists, again, if they understand what is the reasoning behind this, and also for them to have training. And even if there are other centers performing vacuum assisted excision to be able to go and speak to those pathologists to understand how best to handle the specimens, I think is really, really important. And then often you'll find after you've done 4 or 5 cases that you become extremely confident in what you're doing. So when you start out, don't go for difficult cases. Go for straightforward cases where you can succeed in doing your um procedure and um so you can have an understanding of the technique, the the equipment, and then you can progress to more difficult lesions because by then you will have mastered how to perform the technique and then what you're using are your clinical tools. Your skill set to be able to maneuver patients in a different position so that you can target and biopsy the lesion. So start off with reasonably sized lesions, straightforward and build and build and then start going for the more difficult lesions. One of the challenges that I've noted when I've visited many, many countries is centered around the reimbursement. Um, and that is a really difficult topic because each country, and even each region may have their own policies. And again, um, it's trying to understand that and how can you work around that if possible. And again, what I would say is working with societies is really important. As an individual we won't get very far, but if we can show evidence and data that this could be changed practice changing for our patients and for the department. Then what you will find is that more departments will get on board, societies will get on board, and you'll have a louder and more important voice. So work collectively and um and remember you will have other hospitals that may be delivering the service, so do that peer connect. I think that's really important as well. Don't ever feel that you're on your own. And what you'll also find is with your application specialist, they will be able to connect you with different people. And, um, and the other thing is, people do get worried about the complications. Because obviously, you're doing, um, a bigger biopsy, so with bruising, hematoma, skin tear. So, people do get frightened. But remember, complications can come with any needle gauge. They can come with FNA, they can come with core biopsy, and they can also come with vacuum assisted biopsy. But what's really important is that you're prepared. So when people understand, for example, a vacuum assisted breast biopsy is you are taking larger tissue samples, but remember you're aiming to obtain a diagnosis. So with a vacuum assisted breast biopsy, you're replacing the needle core biopsy with a vacuum assisted breast biopsy to make a diagnosis. So you're taking minimum number of samples. You will still apply compression after the biopsy. And often we will apply 10 minutes of nonstop compression. And you're not compressing where you've made the incision in the skin. What you're doing is compressing alongside the biopsy tract. And that's really important. Now, if a patient is bleeding during the biopsy, which you can see because you get the vacuum, Then you might press longer, so you might choose to press for 15 minutes or 20 minutes. But the other thing that you can also do is instead of doing a simple dressing, you might decide to do a pressure bandage because remember you're in the room, you're seeing what's happening. And you have control subsequently of how you manage that patient. And patient communication is really important. So if you tell the patient what you've done, what they need to look out for, and they're more aware, then what you'll find is that they're less anxious. So that's really important because in my time of having done vacuum assisted excision for since 2009 I've not had a patient hospitalized. So they've never had to go to theater because of excessive bleeding. We've always been able to manage the hematoma. Wow, I've really enjoyed this discussion and, and learning about how vacuum-assisted excision has changed things um for B3 lesions and how really you have led the way, um, and for all of us to, to learn and try to apply some of the same principles and guidelines to our practices. So, um, as any, any parting words for, um, clinicians who are considering vacuum assisted incision, any salient points that you think are essential for them to consider? I think it's really important to remember the patient, um, and you're trying to stop women from going for surgery, and we now have the tools that can allow us to do that. Vacuum assisted excision is effective interventional tool. And with local anesthesia, patients can go home. So remember, by um because there's just one more point I'd like to make that with vacuum assisted excision, because we've been using it in the UK to manage B3 lesions and people have recognized the value of it, they've now extended the role of vacuum assisted excision, not only for managing B3 lesions, but for managing good prognostic cancers, for assessing residual tumor post neoadjuvant chemotherapy. And what's really important is that the radiologist plays a key role in being able to deliver that service. And I think one of the. Additional benefits, which I didn't really realize about, um, managing B3 lesions with vacuum assisted, um, excision, is that it raised the profile of the radiologist. In this modern era where we are trying to minimize overtreatment. Oncologists and surgeons now recognize the importance of including radiologists. Because we deliver the minimal intervention. So I think that, so when I say to clinicians when you're starting out, remember your your driving force, your innovation is to improve patient care. And in doing so, you will develop skills that will allow you to widen that scope. So I think the future is really really exciting for us as radiologists and I think we've got a more important role to play in the treatment um area as well and not just in the diagnostic. So remember learning new skills is really exciting, it's scary, but it's exciting, but you're not alone. So engage your experts, your application specialists, speak to your colleagues, work as a team and together you can make that difference. What a wonderful positive note for us to uh end our conversation here today. Uh, so, I'd like to thank you, uh, Doctor Sharma, for sharing your expertise and your practical insights with us. And your, your perspectives have been incredibly valuable and insightful. I truly appreciate the time you've taken, uh, to be here with us today. I'd also like to thank our audience for listening. We hope today's conversation provided useful takeaways that you could apply in your own practice and that it would spark new ideas for learning and discussion and ultimately to make things better for our patients. Thank you again to Doctor Shakiri and Doctor Sharma for sharing your time, expertise, and practical insights. Discussions like these highlight how advances in breast biopsy extend beyond tissue sampling alone. Emphasizing the importance of imaging pathology concordance, thoughtful patient selection, multidisciplinary collaboration, and informed decision making to help optimize patient outcomes and enhance the overall breast care journey. Thanks for being part of the BD Advanced Community. This podcast is intended for educational purposes only. Follow and subscribe so you never miss an episode. For more clinical education, visit advancedEDU.BD.com. We look forward to continuing the conversation in our next episode. BD and the BD logo are trademarks of Becton Dickinson and Company or its affiliates. Copyright 2026 BD. All rights reserved. Published Created by
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