Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy

Ivan, Doina; Selinko, V.; Şahin, Ayşegül; Sneige, Nour; Middleton, Lavinia P.

doi:10.1038/modpathol.3800014

Cited by 124 publications

(76 citation statements)

References 12 publications

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“…The location of the papillary lesion is another widely studied risk factor. Some studies reported a tendency for the papillary lesion to be malignant if it was located at the periphery of the breast (19,20), whereas no such association was found in many other studies, including the present study (3,6,8).…”

Section: Discussioncontrasting

confidence: 51%

“…Reported upgrading rates from benign papillary lesions diagnosed by CNB to malignant papillary lesions diagnosed on subsequent surgical excision range from 0% to 29% (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Some investigators have suggested that benign papillary lesions without atypia diagnosed by CNB, in combination with concordant imaging findings, can be safely followed without further surgery (2-7).…”

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confidence: 99%

“…Because the presence vs. absence of a continuous basally-oriented myoepithelial cell layer is the key feature distinguishing benign from malignant papillary breast lesions (1,3), it is difficult for a pathologist to distinguish among benign, atypical, and malignant lesions on the basis of limited and fragmented tissue obtained from CNB (1)(2)(3).…”

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confidence: 99%

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Upgrading rate of papillary breast lesions diagnosed by core-needle biopsy

Wiratkapun

Keeratitragoon²,

Lertsithichai³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to estimate the upgrading rate of core-needle biopsy (CNB)-diagnosed papillary breast lesions to atypical or malignant papillary lesions on subsequent surgery. MATERIALS AND METHODSWe performed a retrospective review of medical records and imaging findings of patients diagnosed by CNB as having papillary lesions from January 1, 2005 to May 31, 2011. Outcomes were determined by pathology findings from surgical excision or by imaging findings at 12 months follow-up. RESULTSOf 130 papillary lesions in 127 patients, the upgrading rates were 0% for benign papillary lesion to malignancy, 19% for benign papillary lesion to atypical papillary lesion, and 31% for atypical lesion to malignancy. Most of the malignancies were ductal carcinoma in situ. The presence of malignant lesions was related to specific symptoms (palpable mass or nipple discharge; P = 0.020) and to a higher Breast Imaging Reporting and Data System (BIRADS) category (P = 0.017). CONCLUSION CNB is accurate in the diagnosis of benign papillary lesions. If no atypical cells are present, no malignancy is found. The presence of atypia on CNB strongly indicates a need for surgical excision.

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confidence: 51%

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confidence: 99%

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Upgrading rate of papillary breast lesions diagnosed by core-needle biopsy

Wiratkapun

Keeratitragoon²,

Lertsithichai³

et al. 2013

Diagn Interv Radiol

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“…However, the radiology-pathology correlation data are either missing or incomplete in many studies. 4 Studies that have included radiology-pathology correlation for core biopsy cases with papillomas 22,23 and lobular neoplasia [24][25][26] tend to report lower upgrade rates and may argue against mandatory excision for these diagnoses on core biopsy. Similarly, our overall upgrade rate of 7% for cases with careful correlation is lower than the majority of published studies with 30 or more excisions (Table 4) and closer to the 9.5% reported by Bianchi et al 27 in a series of 589 cases from multiple hospitals in Italy.…”

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confidence: 99%

Management of flat epithelial atypia on breast core biopsy may be individualized based on correlation with imaging studies

et al. 2015

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Flat epithelial atypia of the breast commonly co-exists with atypical ductal hyperplasia, lobular neoplasia, and indolent forms of invasive carcinomas such as tubular carcinoma. Most patients with pure flat epithelial atypia on core biopsy undergo surgical excision to evaluate for carcinoma in the adjacent breast tissue. Studies to date have reported varying upgrade rates with most recommending follow-up excision. These studies have often lacked detailed radiographic correlation, central review by breast pathologists and information regarding the biology of the carcinomas identified upon excision. In this study, we report the frequency of upgrade to invasive carcinoma or ductal carcinoma in situ in excision specimens following a diagnosis of pure flat epithelial atypia on core biopsy. Radiographic correlation is performed for each case and grade/receptor status of detected carcinomas is reported. Seventy-three (73) core biopsies containing pure flat epithelial atypia were identified from our files, meeting inclusion criteria for the study. In the subsequent excision biopsies, five (7%) cases contained invasive carcinoma or ductal carcinoma in situ and seventeen (23%) contained atypical ductal hyperplasia or lobular neoplasia. All of the ductal carcinoma in situ cases with estrogen receptor results were estrogen receptor positive and intermediate grade. The invasive tumors were small (pT1a) hormone receptorpositive, HER2-negative, low-grade invasive ductal or tubular carcinomas with negative sentinel lymph-node biopsies. No upgrades were identified in the 14 patients who had all of their calcifications removed by the stereotactic core biopsy. Our rate of upgrade to carcinoma, once cases with discordant imaging are excluded, is at the lower end of the range reported in the literature. Given the low upgrade rate and indolent nature of the carcinomas associated with flat epithelial atypia, case management may be individualized based on clinical and radiographic findings. Excision may not be necessary for patients without remaining calcifications following core biopsy.

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“…Although it is accepted practice that intraductal papillomas with associated atypia or malignancy diagnosed on core needle biopsy must be excised, [1][2][3][4][5] the treatment of pure intraductal papillomas, that is, without atypia or malignancy diagnosed on core needle biopsy was and remains controversial. 1,6 Earlier series attempting to resolve these issues indicated a small but definite risk for atypia (15%-37.5%) or malignancy (15%-17%).…”

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Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy

Jaffer

Nagi

Bleiweiss

2009

Cancer

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BACKGROUND: Although it has been accepted that intraductal papillomas with atypia or malignancy diagnosed on core needle biopsy require surgical excision, the management of pure intraductal papillomas has been controversial. Because some series reported a small but definite incidence of atypia or malignancy, whereas others claimed that radiologic follow‐up was adequate, this study evaluated results of excision of all pure intraductal papillomas diagnosed on core needle biopsy at this institution. METHODS: By using computerized pathology files from January of 2000 to December of 2004, 200 cases of intraductal papillomas on core needle biopsy were identified. Information regarding excision was available in 104 cases. All specimens were reviewed to confirm both the diagnoses as well as the presence of biopsy site changes in excision specimens, and the findings were correlated with radiologic data. RESULTS: The age of the patients ranged from 25 to 82 years (mean, 55.5). The diagnoses on excision were as follows: intraductal papillomas = 71 cases (68.3%), no residual intraductal papillomas = 16 (15.3%), atypical duct hyperplasia = 8 (7.7%), ductal carcinoma in situ = 6 (5.8%), and invasive carcinoma = 3 (2.9%). In cases with atypia or malignancy, these findings were adjacent to but not in the biopsy site. In cases with atypical duct hyperplasia or ductal carcinoma in situ, a spectrum of histologic changes ranging from florid to atypical duct hyperplasia (14 cases), to ductal carcinoma in situ (6 cases) were present, all involving intraductal papillomas. CONCLUSIONS: The upstage rate of pure intraductal papillomas on core needle biopsy to atypia or malignancy on excision was 16.4%. Because of sampling error and the close proximity of atypia or malignancy to the intraductal papillomas (suggesting precancerous potential), excision was recommended of these lesions diagnosed on core needle biopsy. Close radiologic‐pathologic correlation was important in the evaluation of these lesions. Cancer 2009. © 2009 American Cancer Society.

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Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy

Cited by 124 publications

References 12 publications

Upgrading rate of papillary breast lesions diagnosed by core-needle biopsy

Upgrading rate of papillary breast lesions diagnosed by core-needle biopsy

Management of flat epithelial atypia on breast core biopsy may be individualized based on correlation with imaging studies

Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy

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