Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up.
ABSTRACT Papillary breast lesions comprise a spectrum of histopathologic diagnoses ranging from benign papillomas to papillary carcinomas. There is ongoing controversy regarding the management of papillary lesions diagnosed by core needle biopsy (CNB). Some authors advocate observation of papillary lesions when the CNB is benign, while others recommend surgical excision of all papillary lesions. The current study assessed the adequacy of CNB in evaluating papillary breast lesions.
A search of the pathology database at our institution identified 122 papillary lesions diagnosed by CNB. The study population consisted of 71 papillary lesions that were subsequently surgically excised.
Of the 71 papillary lesions excised, 8 were malignant, 16 were atypical, and 47 were benign at the time of CNB. Of the 47 papillary lesions thought to be benign, 13 (28%) revealed atypia and 4 (9%) revealed malignancy upon surgical excision. Of the 13 atypical papillary lesions on CNB, 7 lesions (54%) were associated with malignancy upon excision. Slightly over half the upgrades were due to finding atypia or malignancy in the tissue surrounding the papillary lesion. The total rate of upgrades from the CNB diagnosis to the excisional diagnosis was 38%.
When a core biopsy of a papillary lesion is encountered, there is a strong likelihood of discovering atypia or malignancy in the index lesion or in close proximity. Therefore, surgical excision should be performed to avoid missing a malignancy and to allow for accurate breast cancer risk assessment that can impact survival and decisions regarding chemoprevention.
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ABSTRACT: Imaging abnormalities detected by mammographic screening often lead to diagnostic evaluations, with suspicious abnormalities subjected to image-guided core needle biopsy (CNB) to exclude malignancy. Most CNBs reveal benign pathological alterations, termed benign breast disease (BBD). Adoption of CNB presents challenges with pathologic classification of breast abnormalities and management of patients with benign or atypical histological findings. Patient management and counseling after CNB diagnosis of BBD depends on postbiopsy determination of radiologic-pathologic concordancy. Communication between radiologists and pathologists is crucial in patient management. Management is dependent on the histological type of BBD. Patients with concordant pathologic imaging results can be reassured of benign biopsy findings and advised about the future risk of developing breast cancer. Surgical consultation is advised for patients with discordant findings, symptomatic patients, and high-risk lesions. This review highlights benign breast lesions that are encountered on CNB and summarizes management strategies. For this review, we conducted a search of PubMed, with no date limitations, and used the following search terms (or a combination of terms): atypical ductal hyperplasia, atypical hyperplasia, atypical lobular hyperplasia, benign breast disease, cellular fibroepithelial lesions, columnar cell lesions, complex sclerosing lesion, core needle biopsy, fibroadenomas, flat epithelial atypia, lobular carcinoma in situ, lobular neoplasia, mucocele-like lesions, phyllodes tumor, pseudoangiomatous stromal hyperplasia, radial scar, and vascular lesions. The selection of references included in this review was based on study relevance and quality. We used additional articles culled from the bibliographies of retrieved articles to examine the published evidence for risk factors of BBD.Mayo Clinic Proceedings 04/2014; 89(4):536–547. · 5.79 Impact Factor
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ABSTRACT: Intraductal papillomas (IDPs) of the breast can be associated with a variety of clinical symptoms and radiologic findings. Surgical excision is often recommended based on the possibility of an associated high-grade lesion. Although the rate of upgrades has been extensively evaluated for IDPs, many studies are hindered by broad inclusion criteria, a lack of pathologic-radiologic concordance, and no standard definition of what constitutes an upgrade. In the current study, we evaluate the risk of upgrade for a specific subset of IDPs: non-mass-associated IDPs. We identified all breast needle core biopsies with a diagnosis of IDP between 2003 and 2010. Patients with associated masses, architectural distortion, or ipsilateral breast cancer were excluded. All needle core biopsy slides and relevant imaging studies were reviewed to ensure pathologic-radiologic concordance. Excision pathology was also reviewed; an upgrade was defined as the presence of ductal carcinoma in situ or invasive carcinoma in the excision. Seventy-nine IDPs that met inclusion criteria were identified and were further divided into 3 histologic categories: micropapilloma, fragmented IDP, and atypical IDP. Micropapillomas and fragmented IDPs had no upgrades (0/37). In patients who did not undergo excision, none subsequently developed ipsilateral breast cancer (follow-up, 50-61 months). This is in contrast to atypical IDPs that had a 33% upgrade rate. One patient with an unexcised atypical IDP developed ipsilateral breast cancer within 2 years. Our data suggest that conservative follow-up is reasonable for non-mass-associated IDPs without atypia regardless of microscopic size, provided that careful pathologic-radiologic correlation is achieved.Human pathology 11/2013; · 2.81 Impact Factor
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ABSTRACT: Sonographic examination of the breast with state-of-the-art equipment has become an essential part of the clinical work-up of breast lesions and a valuable adjunct to mammographic screening and physical examination. Fine-needle aspiration (FNA) and core-needle biopsy (CNB) are well-established, valuable techniques that are still used in most cases, whereas vacuum-assisted breast biopsy (VABB) is a more recent technique. VABB has proven clinical value and can be used under sonographic, mammographic, and magnetic resonance imaging guidance. The main indication for the use of VABB is for biopsies of clustered microcalcifications, which are usually performed under stereotactic guidance. This method has been proven reliable and should replace surgical biopsies. The ultrasound-guided procedure is still more a matter of discussion, but it should also replace surgical biopsies for nodular lesions, and it should even replace surgery for the complete removal of benign lesions. This viewpoint is gradually gaining acceptance. Different authors have shown increased diagnostic accuracy of VABB compared to FNA and CNB. VABB particularly leads to less histological underestimation. The other indications for VABB are palpable or nonpalpable nodular lesions or American College of Radiology Breast Imaging Reporting and Data System 3 and 4A lesions. For masses that are likely benign or indeterminate, we attempt to completely remove the lesion to eliminate uncertainty on later follow-up images. VABB offers the best possible histological sampling and aids avoidance of unnecessary operations. VABB complications include bleeding or pain during the procedure, as well as postoperative pain, hemorrhaging, and hematomas. But, these hemorrhaging could be controlled by the post-procedural compression and bed resting. Overall, VABB is a reliable sampling technique with few complications, is relatively easy to use, and is well-tolerated by patients. The larger amount of extracted tissue reduces sampling error.Gland surgery. 05/2014; 3(2):120-7.