Pathologic Outcomes of Nonmalignant Papillary Breast Lesions Diagnosed at Imaging-guided Core Needle Biopsy

Holley, Susan; Appleton, Catherine M.; Farria, Dione M.; Reichert, Valerie C.; Warrick, Joshua; Allred, D. Craig; Monsees, Barbara

doi:10.1148/radiol.12111926

Cited by 60 publications

(42 citation statements)

References 34 publications

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“…Shouhed et al [36] reported six upgrades to malignancy though they did not specify whether they were with ultrasound or stereotactic guidance; therefore, the actual number initially diagnosed with stereotactic guidance may be higher. As opposed to the current study, most of the studies reporting upgrades after VACNB [26,36,43] did not specify imaging findings leading to biopsy for individual cases. Liberman et al [22] reported that of two upgrades, one was after a biopsy for calcifications while the other one was after biopsy of a mass.…”

Section: Discussioncontrasting

confidence: 60%

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

et al. 2015

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Section: Discussioncontrasting

confidence: 60%

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

et al. 2015

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“…Holley et al 24 report a lower median number of cores obtained at CNB of IDPs without upgrade (3; range 1-7) compared to IDPs with upgrade (5; range 2-21). The median number of cores in our cohort was 6 (range 2-16), similar to the median number of cores in a study of 80 IDPs and no upgrades by Wiratkapun et al (6; range 2-16) 25 .…”

Section: Discussionmentioning

confidence: 99%

Breast intraductal papillomas without atypia in radiologic‐pathologic concordant core‐needle biopsies: Rate of upgrade to carcinoma at excision

Pareja

Corben

Brennan

et al. 2016

Cancer

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Background The surgical management of breast intraductal papilloma without atypia (IDP) identified at core needle biopsy (CNB) is controversial. We assessed the rate of upgrade to carcinoma at surgical excision, and identified parameters predictive of upgrade. Methods We identified women with CNB diagnosis of intraductal papilloma without atypia or carcinoma at our center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. We correlated the radiologic and clinicopathologic features of patients with CNB diagnosis of IDP with upgrade to carcinoma at surgical excision. Results Our study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent excision. The upgrade rate was 2.3% (4/171). The upgrade lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥8 mm away. Twenty-four women (25 IDPs) did not undergo excision, and had stable imaging at follow-up (median of 23.5 months). Conclusions The upgrade rate at excision of IDP diagnosed at CNB with radiologic-pathologic concordance is 2.3%. Our findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size.

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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%

“…Jung et al [7] and Sakr et al [13] reported that mammographic abnormality was related to higher upgrade rate. Holley et al [12] found that patients with upstaged lesions were more likely to have a mass than calcification at imaging. Therefore, subsequent excision might be a better choice for patients who have a mammographic abnormality associated with a mass on US.…”

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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Pathologic Outcomes of Nonmalignant Papillary Breast Lesions Diagnosed at Imaging-guided Core Needle Biopsy

Abstract: Given the substantial upstage rate (11%) of papillary lesions diagnosed at imaging-guided CNB, surgical excision is an appropriate management decision; however, careful evaluation in concert with an expert breast pathologist may allow for observation in appropriately selected patients.

Cited by 60 publications

References 34 publications

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

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

Breast intraductal papillomas without atypia in radiologic‐pathologic concordant core‐needle biopsies: Rate of upgrade to carcinoma at excision

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

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