Comparison of Sonographically Guided Core Needle Biopsy and Excision in Breast Papillomas

Abstract

Objectives The aim of this study was to evaluate the clinical factors and sonographic features of benign papillomas of the breast proven by sonographically guided 14‐gauge core needle biopsy and their upgrade or malignancy rate after sonographically guided vacuum‐assisted excision or surgical excision. Methods We reviewed the medical records of patients who underwent core needle biopsy from July 2005 to December 2011. We evaluated 39 benign papillomas without atypia in 34 patients. The papillomas were diagnosed by core needle biopsy and underwent surgical or vacuum‐assisted excision. After core needle biopsy, imaging‐histologic correlation was performed to determine concordance. The upgrade and malignancy rates were assessed after surgical or vacuum‐assisted excision, and associated clinical and radiologic factors, including patient age, lesion size, distance from the nipple, sonographic features, and American College of Radiology Breast Imaging Reporting and Data System (BI‐RADS) category were evaluated. Results Three lesions (7.7 %) among 39 papillomas were upgraded to papilloma with atypia after surgical excision. There was no malignancy after excision. The upgrade rates for BI‐RADS categories 3, 4a, 4b, and 4c were 0%, 6.9%, 0%, and 20%, respectively. There were no significant differences in the upgrade to papilloma with atypia in terms of the presence of symptoms, lesion size, distance from the nipple, BI‐RADS category, or imaging‐histologic correlation. Conclusions Prediction of papilloma with atypia, not malignancy, was challenging because there were no associated clinical or radiologic factors to predict papilloma with atypia before excision. However, there was no malignancy after excision. Therefore, intensive surveillance is preferable to immediate surgical excision for benign papillomas diagnosed on core needle biopsy.

Outcomes of benign breast papillomas diagnosed at image-guided vacuum-assisted core needle biopsy

“…The published literature reports upgrade rates to carcinoma following a diagnosis of benign papilloma at CNB ranging from 0% to 29% [1][2][3]. Some authors believe that benign papillomas diagnosed at CNB with imaging concordance may be safely managed with clinical and imaging follow-up [6,7,[12][13][14][15][16][17][18][19][20]. Others advocate surgical excision to exclude any associated malignancy [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38].…”

Shear-Wave Elastography for the Differential Diagnosis of Breast Papillary Lesions

“…Although the management of benign papillary lesions diagnosed at CNBs is still controversial [2–6], the current management of benign papillary lesions diagnosed at CNBs is US-guided VAE [4–7]. Thus, predicting atypical or malignant papillary lesions on US could be helpful for the management.…”

“…Previous studies [2, 3] have reported that surgical excision is recommended for an accurate diagnosis of benign papilloma diagnosed using ultrasound (US)-guided CNB. In contrast, some studies have reported that US-guided vacuum-assisted excision (VAE) is accurate and could be an alternative to surgery for benign papillary lesions [4–7]. Sohn et al [4] reported no malignancies after excising benign papilloma diagnosed by US-guided CNB.…”

“…In contrast, some studies have reported that US-guided vacuum-assisted excision (VAE) is accurate and could be an alternative to surgery for benign papillary lesions [4–7]. Sohn et al [4] reported no malignancies after excising benign papilloma diagnosed by US-guided CNB. Ko et al [5] suggested that well-selected benign papilloma (category 3 or 4A papillary lesions < 1.5 cm) can be treated with US-guided VAE rather than surgical excision.…”

“…Ko et al [5] suggested that well-selected benign papilloma (category 3 or 4A papillary lesions < 1.5 cm) can be treated with US-guided VAE rather than surgical excision. Although management of breast papillary lesions is controversial, the current trend is to use US-guided VAE for well-selected benign papillary lesions diagnosed by US-guided CNB [4–7]. In contrast, papillary lesions with atypia should be treated by surgical excision [6, 7].…”