Papillary Lesions of the Breast at Percutaneous Core-Needle Biopsy1

Columbia University, New York, New York, United States
Radiology (Impact Factor: 6.87). 04/2006; 238(3):801-8. DOI: 10.1148/radiol.2382041839
Source: PubMed


To retrospectively review the imaging and histologic findings in patients in whom a benign papillary lesion was diagnosed at core-needle breast biopsy.
This retrospective study was approved by the institutional review board at each institution; patient consent was not required. The study was HIPAA compliant. The authors reviewed the findings from 42 patients (age range, 26-76 years; mean age, 54.3 years) with 43 benign papillary lesions diagnosed at core-needle biopsy. Thirty-six (84%) of the 43 lesions were surgically excised, and seven (16%) were followed up with long-term imaging. The authors assessed the radiographic findings, the histologic findings at core-needle biopsy, and the findings at subsequent surgical excision or imaging follow-up. Statistical analysis was performed on a per-patient basis and included the Blyth-Still-Casella procedure to construct exact 95% confidence intervals (CIs) and the Fisher exact test.
At core-needle biopsy, lesions were diagnosed as papilloma (n = 29), sclerosing papilloma (n = 8), and benign papillary lesions not otherwise specified (n = 6). For the 36 lesions that were surgically excised, histologic follow-up showed no residual lesion in 10, intraductal papilloma in 14, intraductal papillomatosis in two, papilloma with adjacent foci of atypical ductal hyperplasia (ADH) in eight, and well-differentiated papillary ductal carcinoma in situ (DCIS) in two. Mammographic follow-up in the remaining seven lesions revealed stable calcifications in five (at 28-55 months) and no residual lesion in two (at 26-29 months). In nine of the 42 patients (21%), the diagnosis was upgraded to either ADH or DCIS (exact two-sided 95% CI = 11.4%, 36.4%).
The results strongly suggest that papillary lesions diagnosed as benign at core-needle biopsy should be surgically excised because a substantial number of lesions were upgraded to ADH and DCIS at excision.

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    • "The five lesions with papilloma at biopsy histology were found to be benign papillomas in four cases and atypical papilloma in one case at surgery. Recent studies have concluded that benign papillomas detected by core needle biopsy should be surgically excised, because 21-31% of the benign papillary lesions were upgraded to high-risk lesions or cancer at surgery (15, 16). However, it remains to be determined whether an US-DVAR diagnosis of benign papilloma can obviate the need for surgical excision, which is beyond the scope of this study. "
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    ABSTRACT: To evaluate whether the removal of an intraductal mass using an ultrasound (US)-guided directional vacuum-assisted device can eliminate symptoms in patients presenting with abnormal nipple discharge. Between March 2004 and October 2006, 36 patients who presented with abnormal nipple discharge, underwent US-guided, 11-gauge vacuum-assisted biopsy for a benign intraductal single mass on US. The ability of the procedure to eliminate nipple discharge was evaluated by physical examination during follow-up US. Lesion characteristics, biopsy variables, and histologic features were analyzed to identify factors affecting symptom resolution. Of the 36 lesions, 25 (69%) were intraductal papillomas, 10 (28%) were fibrocystic changes, and one (3%) was a fibroadenoma. The nipple discharge disappeared in 69% (25 of 36) of the women at a mean follow-up time of 25 months (range 12-42 month). There was no difference in the lesion characteristics, biopsy variables, and the histologic features between groups that eliminated the symptom compared those with persistent nipple discharge. US-guided directional vacuum-assisted removal of an intraductal mass appears to eliminate nipple discharge in only 69% of patients and thus, it should not be considered as an alternative to surgical excision.
    Full-text · Article · Oct 2009 · Korean journal of radiology: official journal of the Korean Radiological Society
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    • "As discussed above, the literature suggests that the risk of malignancy is in the range of 4% to 8%. This risk is comparable to that associated with radial scar or papillary lesion with no epithelial atypia [7, 34, 35, 40, 53]. Both radial scars and papillary lesions are excised in many centres according to current guidance [19]. "
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    ABSTRACT: The management of a core biopsy diagnosis of lobular neoplasia is controversial. Detailed radiological-pathological review of 47 patients with cores showing classical lobular neoplasia was performed (patients with pleomorphic lobular carcinoma in situ (LCIS) or associated risk lesions were considered separately). Immediate surgical excision in 25 patients showed invasive carcinoma in 7, ductal carcinoma in situ (DCIS) in 1 and pleomorphic LCIS in 1; radiological-pathological review showed that the core biopsy missed a mass in 5, missed calcification in 2 and that calcification appeared adequately sampled in 2. Nineteen patients had follow-up of at least 2 years. Four patients developed malignancy at the site of the core biopsy (invasive carcinoma in three, DCIS in one); one carcinoma was mammographically occult, one patient had dense original mammograms and two had calcifications apparently adequately sampled by the core. In conclusion, most carcinomas identified at the site of core biopsy showing lobular neoplasia were the result of the core missing the radiological lesion, emphasising the importance of multidisciplinary review and investigation of any discordance. Some carcinomas were found after apparently adequate core biopsy, raising the question of whether excision biopsy should be considered after all core biopsy diagnoses of lobular neoplasia.
    Full-text · Article · Jun 2008 · Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin
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    • "Controversy still persists regarding the need for excision of papillomas that are diagnosed upon percutaneous breast biopsy (22, 23). In a recent study by Liberman et al. (23), cancer was found in five (14%) of the 35 lesions that yielded a benign, concordant diagnosis of papilloma upon percutaneous biopsy. "
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    ABSTRACT: We wanted to assess the need for surgical excising papillary lesions of the breast that were diagnosed upon sonographically guided 14-gauge core needle biopsy. Sixty-nine women (age range: 25-74 years, mean age: 51.7 years) with 69 papillary lesions (4.9%) were diagnosed and followed after performing sonographically guided 14-gauge core needle biopsies. Surgical excision was performed for 44 (64%) of 69 papillary lesions, and 25 lesions were followed with imaging studies (range: 6-46 months, mean: 17.9 months). The histologic findings upon core biopsy were compared with the surgical, imaging and follow-up findings. Core needle biopsies of 69 lesions yielded tissue that was classified as benign for 43 lesions, atypical for 18 lesions and malignant for eight lesions. Of the 43 lesions that yielded benign papilloma upon core needle biopsy, one had intraductal papillary carcinoma found upon surgery. An immediate surgical biopsy was recommended for this lesion because of the imaging-histologic discordance. No additional carcinoma was found during the imaging follow-up. Surgical excision was performed for 17 atypical papillary lesions, and this revealed intraductal (n = 6) or invasive (n = 2) papillary carcinoma in 8 (47%) lesions. Of the seven intraductal papillary carcinomas, surgery revealed invasive papillary carcinoma in one (14%). Our results suggest that papillary lesions of the breast that are diagnosed as benign upon sonographically guided 14-gauge core needle biopsy can be followed when the results are concordant with the imaging findings.
    Full-text · Article · Jun 2007 · Korean Journal of Radiology
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