Papillary Lesions of the Breast With and Without Atypical Ductal Hyperplasia Can We Accurately Predict Benign Behavior From Core Needle Biopsy?

Department of Pathology, University of Washington Medical Center, Seattle 98195, USA.
American Journal of Clinical Pathology (Impact Factor: 3.01). 10/2004; 122(3):440-3. DOI: 10.1309/NAPJ-MB0G-XKJC-6PTH
Source: PubMed

ABSTRACT Evaluation of papillary lesions of the breast can be difficult, and in core needle biopsy specimens, accurate diagnosis is challenging. Initial studies suggested that all papillary lesions revealed by core biopsy required surgical excision. Recent data suggest that only papillary lesions with atypical ductal hyperplasia (ADH) revealed by core biopsy need surgical excision. We evaluated our experience at the University of Washington Medical Center, Seattle, with papillary lesions with and without ADH on core biopsy to determine whether diagnostic accuracy can be achieved. In 51 core biopsy specimens, we evaluated the presence or absence of ADH: 25 were benign papillomas; 26 were papillomas with ADH. Surgical follow-up was available for 36 cases (11 papillomas and 25 papillomas with ADH). Clinical (radiologic) follow-up was available in 5 papilloma cases (average follow-up, 35.6 months). Follow-up revealed that all papillomas on core biopsy were benign. Excisional biopsy revealed ductal carcinoma in situ or invasive carcinoma in 12 (48%) of 25 papillary lesions with ADH. Benign papillomas can be adequately diagnosed with core biopsy. All papillary lesions with ADH require surgical excision owing to the high rate of associated neoplasia.

  • [Show abstract] [Hide abstract]
    ABSTRACT: ObjectiveTo prospectively determine the upgrade rate following surgery in benign papilloma initially diagnosed at ultrasound (US)-guided 14-gauge gun biopsy. MethodsA total of 128 benign papillomas were diagnosed in 114 patients after a US-guided biopsy. Surgical excision was recommended where the biopsy indicated benign papilloma, regardless of imaging findings. The upgrade rate to ‘atypical’ and ‘malignancy’ was measured on a per-lesion basis. We analysed potential associations between clinical presentation, lesion variables and the results of surgical excision (using logistic regression). ResultsOf the 114 patients, 87 eventually underwent surgery: among the 100 supposed benign papillomas, surgical excision revealed fibrocystic change or no residual lesion in nine cases, intraductal papilloma in 74, atypical papilloma in 13, papillary ductal carcinoma in situ (DCIS) in three and one invasive papillary carcinoma. The upgrade rate for an atypical papilloma or papilloma with adjacent foci of atypical ductal hyperplasia (ADH) and malignancy was 13% (95% CI = 7.1–21.2%) and 4% (95% CI = 1.1–9.9%), respectively. The mean lesion size (P = 0.041) was significantly larger when lesions were upgraded to malignancy. Other features were not significantly associated with pathological underestimation (P > 0.05). ConclusionSurgical excision should be considered for benign intraductal papillomas above 1.5cm in size. KeywordsBenign papilloma-Atypical papilloma-Papillary ductal carcinoma in situ-Invasive papillary carcinoma-US-guided 14-G gun biopsy
    European Radiology 05/2010; 20(5):1093-1100. DOI:10.1007/s00330-009-1649-2 · 4.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Papillary neoplasms of the breast represent a complex spectrum ranging from benign to malignant lesions. The myoepithelial cell (MEC) layer is generally continuous in papillomas and increasingly discontinuous to absent in atypical and malignant counterparts. Identification of MECs can be difficult on morphological grounds and currently relies on immunomarkers. We investigated the potential role of p63 and CD10 in 20 papillary lesions and compared them with 1A4 and calponin. In 18 cases, adjacent normal breast tissue was available for study. All four markers were diffusely positive in all samples of normal tissue and benign papillomas indicating similar sensitivity in the identification of MECs. Intense positivity was found in 100% of the cases with 1A4 and CD10, but in only 76% with calponin and in 60.5% with p63 (differences statistically significant, p < 0.05), suggesting that the former two render more reproducible results. The most specific markers were p63 and CD10 which showed cross-reactivity in 0% and in up to 33% of the cases respectively. 1A4 and calponin showed diffuse cross-reactivity in all cases. When assessing benign versus atypical papillomas, the best parameters were diffuse positivity using CD10 or p63, and continuous MEC layer, mainly using CD10. When comparing benign papillomas to carcinomas all parameters were equally useful with 1A4 and CD10. Regardless of the marker, intense positivity was the only parameter that could distinguish atypical papillomas from papillary carcinomas. p63 staining, which renders a nuclear and mostly discontinuous reactivity, was not as useful as the other markers when the parameter continuous MEC layer was evaluated. Although CD10 seems to combine the highest specificity and reproducibility with a good sensitivity, reproducibility of 1A4 is higher. Thus, a minimum panel to assess papillary lesions should include both markers. Although p63 is the most specific, its nuclear and discontinuous pattern may lead to erroneous diagnosis, especially in the differentiation between benign papillomas and atypical/malignant lesions.
    The Breast Journal 01/2008; 14(1):68-75. DOI:10.1111/j.1524-4741.2007.00518.x · 1.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recently, the incidence of non-palpable or noninvasive breast cancer has increased. Consequently, criteria for choosing procedures to obtain pathological materials had changed. Fine needle aspiration biopsy cytology (FNA) and core needle biopsy (CNB) are both reliable procedures for detecting breast cancer. However, for non-palpable lesions, the diagnostic accuracy of CNB is higher. The main limits of FNA are the high rate of insufficient sampling and inability to determine invasiveness. CNB is an established alternative to surgical biopsy, and CNB can avoid excess surgical biopsies in a large number of patients. In addition to accurate histological diagnosis, there is interest in obtaining prognostic information from CNB, especially for patients being considered for preoperative (neoadjuvant) therapy. CNB provides useful information about histologic type and grade. However, an unavoidable problem of CNB is underestimation of invasion. On the other hand, there is good concordance in particular for estrogen receptor (ER) and progesterone receptor (PR) between CNB and surgical excision. Several aspects of CNB remains controversial, such as diagnosing papillary lesions by CNB, problems regarding tumor cell displacement after CNB, and management of lobular neoplasia (LN) on CNB.
    Breast Cancer 02/2005; 12(4):272-8. DOI:10.2325/jbcs.12.272 · 1.51 Impact Factor


Available from