Benign Papillomas Diagnosed on Large-gauge Vacuum-Assisted Core Needle Biopsy which Span &lt;1.5 cm Do Not Need Surgical Excision

Mosier, Andrew; Keylock, Joren; Smith, D.L.

doi:10.1111/tbj.12180

Cited by 30 publications

(25 citation statements)

References 25 publications

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“…Only one study by Chang et al evaluated the accuracy of VAB in PL without atypia by open surgical excision following VAB with no upgrade to malignancy but an upgrade of 18.3 % to atypia [61]. Most studies following up VAB excision of PL without atypia did not observe any upgrade to malignancy with at least 2 years of surveillance [60, 62, 63]. One recorded a minimal underestimation of 1.4 % [64] and another 3.2 % [65].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Rageth

O’Flynn

Comstock

et al. 2016

Breast Cancer Res Treat

189

149

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The purpose of this study is to obtain a consensus for the therapy of B3 lesions. The first International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) including atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumors (PT), and radial scars (RS) took place in January 2016 in Zurich, Switzerland organized by the International Breast Ultrasound School and the Swiss Minimally Invasive Breast Biopsy group—a subgroup of the Swiss Society of Senology. Consensus recommendations for the management and follow-up surveillance of these B3 lesions were developed and areas of research priorities were identified. The consensus recommendation for FEA, LN, PL, and RS diagnosed on core needle biopsy or vacuum-assisted biopsy (VAB) is to therapeutically excise the lesion seen on imaging by VAB and no longer by open surgery, with follow-up surveillance imaging for 5 years. The consensus recommendation for ADH and PT is, with some exceptions, therapeutic first-line open surgical excision. Minimally invasive management of selected B3 lesions with therapeutic VAB is acceptable as an alternative to first-line surgical excision.

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Section: Resultsmentioning

confidence: 99%

“…One reason might be the fact that the size of the PL was not recorded, implying that some PL might not have been completely removed. Mosier et al removed only lesions smaller than 15 mm (range 3–15 mm) to ensure the complete removal of the PL [62]. With this approach, they had no upgrades to malignancy after nearly 9 years.…”

Section: Resultsmentioning

confidence: 99%

First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Rageth

O’Flynn

Comstock

et al. 2016

Breast Cancer Res Treat

189

149

View full text Add to dashboard Cite

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“…The upgrade rate was higher when using CNB than using VAB (p = 0.021). Many studies [2, 11,12] have suggested that a wider biopsy might lead to lower upgrade rate. This seemed to suggest that imaging surveillance might be suitable for small papillomas undergoing VAB.…”

Section: Discussionmentioning

confidence: 99%

Is Surgical Excision Necessary in Breast Papillomas 10 mm or Smaller at Core Biopsy

Yang¹,

Fan²,

Liu³

et al. 2018

Oncol Res Treat

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Background: The objective of this study was to propose managements for breast papillomas of 10 mm or smaller initially diagnosed at core biopsy. Method: We reviewed the data of patients in our center from 2004 to 2013. 116 lesions of 10 mm or smaller as measured by ultrasound (US) were diagnosed as papillomas at core needle biopsy (CNB) or vacuum-assisted biopsy (VAB). 74 of the papillomas diagnosed by CNB were surgically excised, the others were followed by imaging surveillance. Result: 13 of 116 lesions were found to be malignant, with an upgrade rate of 11.2%. Analyzing the difference between malignant and nonmalignant lesions, patients with malignant lesions were older than those with nonmalignant lesions (56.6 vs. 46.6 years, p = 0.002). Papillomas with atypia had a significantly higher upgrade rate than without, both in the surgical results (p = 0.030) and overall (p = 0.0392). None of 16 papillomas larger than 5 mm upgraded to malignancy. Breast papillomas diagnosed by CNB had a significantly higher upgrade rate (16.5%) than those diagnosed by VAB (0%) (p = 0.021). Conclusion: Our finding suggests that breast papillomas of 6-10 mm at initial CNB need additional surgical excision, but imaging surveillance may be suitable for papillomas no larger than 5 mm and papillomas detected by VAB.

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“…In addition, these earlier studies had several imitations, including relatively small study sizes or unconfirmed pathological results from surgery for many cases. Future research with larger studies and sufficient surgical outcomes will be necessary to address these limitations [14151617202324]. …”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy

et al. 2016

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PurposeIntraductal papilloma (IDP) is a benign breast disease with malignant potential, for which complete surgical excision is usually recommended. The aim of the present study was to investigate predictive factors for upgrading patients with a benign papillary lesion (BPL).MethodsThis study was an observational study using a prospectively collected cohort. In total, 13,049 patients who underwent a core needle biopsy (CNB) for a breast lesion between January 2009 and May 2015 were enrolled. We reviewed all patients with pathologically confirmed BPL from a CNB.ResultsSurgical treatment was performed for 363 out of a total of 592 lesions. According to the pathological differences, the lowest upgrade rate was shown in IDP without atypia (without atypia, 6.0%; with atypia, 26.8%; papillary neoplasm, 31.5%; p<0.001). The univariate analysis showed that, in IDP without atypia, the age at diagnosis, size of BPL on ultrasonography, and density on mammography were associated with upgrading. The multivariate analysis revealed that age >54 years and lesion size >1 cm were significantly associated with upgrade to malignancy (odds ratio [OR]=4.351, p=0.005 and OR=4.236, p=0.001, respectively).ConclusionThe indications for surgical treatment can be defined as age >54 years and mass size >1 cm, even in IDP without atypia in the CNB results; this also includes cases of IDP with atypia or papillary neoplasm. Therefore, we suggest that close observation without surgery is sufficient for younger women with a small IDP without atypia.

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Benign Papillomas Diagnosed on Large-gauge Vacuum-Assisted Core Needle Biopsy which Span <1.5 cm Do Not Need Surgical Excision

Cited by 30 publications

References 25 publications

First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Is Surgical Excision Necessary in Breast Papillomas 10 mm or Smaller at Core Biopsy

Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy

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