Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy?
ABSTRACT Debate continues regarding the use of surgical excision in benign papillary lesions initially diagnosed at core biopsy. The objective of this study is to propose management guidelines for benign papillary breast lesions initially diagnosed at core biopsy. Between January 2003 and January 2006, 76 lesions were identified as benign papillary lesions at initial core needle biopsy (n=68) or vacuum biopsy (n=8). After surgical excision, six of the 68 benign papillary lesions initially diagnosed at core needle biopsy were confirmed as malignant papillary neoplasms, giving a false-negative rate of core needle biopsy of 8.8%. Three of the eight atypical papillomas initially diagnosed at core needle biopsy were confirmed as papillary cancer in final pathology, giving a false-negative rate of 37.5%. In the analysis of the difference between benign papillary lesions and atypia or malignant papillary lesions, malignant papillary lesions were located more peripherally (p=0.005) than benign lesions and were larger (>1.5 cm, p=0.017). It is concluded that atypical papillomas at initial core biopsy or large, clinically peripherally located papillomas (>1.5 cm) need additional surgical excision.
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- Breast (Edinburgh, Scotland) 11/2008; 17(6):543-4. DOI:10.1016/j.breast.2008.10.001 · 2.58 Impact Factor
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ABSTRACT: The purpose of this study was to determine the accuracy of core needle biopsy (CNB) diagnoses of papillary breast lesions, and to identify the risk factors and histologic features, compared with excisional biopsy (EB). We retrospectively reviewed 1,682 sonographically guided core needle biopsies performed at one single medical center from January 2001 through December 2005, and identified 41 papillary lesions. Surgical correlation was available for 35 cases, 2 cases were loss follow-up and 4 cases diagnosed as papilloma by core needle biopsy were followed up with imaging for at least 24 months. The pathologic diagnoses for the 35 papillary lesions obtained at core biopsy were benign in 24 cases, atypical in 7, and malignant in 4. Of those diagnosed as benign lesions at CNB, 7/24 turned out to be malignant. In the hyperplasia group, 5/7 were malignant. The total upgrade rate was 39%. The positive predict value was 100% and negative predict value was 61%. All papillary lesions of the breast diagnosed by CNB should be excised because a substantial number of lesions were upgraded of diagnoses at excision.European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 01/2009; 35(1):21-4. DOI:10.1016/j.ejso.2008.06.004 · 2.89 Impact Factor