Percutaneous large-core biopsy of papillary breast lesions.

Liberman, Laura; Bracero, Nanette; Vuolo, Magalis; Dershaw, D. David; Morris, Elizabeth A.; Abramson, A F; Rosen, Paul Peter

doi:10.2214/ajr.172.2.9930777

Cited by 202 publications

(127 citation statements)

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“…Of the 104 cases, 30 were mammotome core needle biopsies, all done for calcifications (14-gauge) and 74 were ultrasound-guided (16-, 18-, or 20-gauge). The average number of ultrasound-guided core cylinders obtained per patient was 5 (range, [3][4][5][6][7][8][9][10][11][12]; for mammotome core needle biopsy it was 15 (range, [10][11][12][13][14][15][16][17][18][19][20]. The diagnoses on the excision specimens were as follows: no residual intraductal papillomas, 16 (15.3%); residual intraductal papillomas, 71 (68.3%); atypical duct hyperplasia, 8 (7.7%); ductal carcinoma in situ, 6 (5.8%); and invasive carcinoma, 3 (2.9%).…”

Section: Resultsmentioning

confidence: 99%

“…1,6 Earlier series attempting to resolve these issues indicated a small but definite risk for atypia (15%-37.5%) or malignancy (15%-17%). [7][8][9][10][11] Initially, some studies failed to find any atypia or malignancy when pure intraductal papillomas were excised [3][4][5]12 and thus advocated against excision. However, more recent series recommend excision because of upstaging of these lesions on excision.…”

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confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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

Jaffer

Nagi

Bleiweiss

2009

Cancer

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“…[1][2][3] Considering that the subsequent decision about clinical management (follow-up vs surgical excision) is now based primarily on the CNB diagnosis, there is an increased interest in establishing reliable and accurate diagnostic criteria for these lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, initial diagnosis by sonographically guided and stereotactic core needle biopsy (CNB) has replaced surgical excision in many institutions. 1,2 Moreover, the subsequent decision about clinical management (follow-up vs surgical excision) is now based primarily on the CNB diagnosis. This emphasizes the importance of establishing reliable and accurate diagnostic criteria for these lesions.…”

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confidence: 99%

“…3 Thus, CNB specimens are best interpreted with a knowledge of the lesion's imaging characteristics, both to ensure a pathologically accurate diagnosis and to assure the radiologist that the targeted lesion was adequately sampled. [1][2][3] The purpose of this study was to determine the accuracy of CNB diagnosis in evaluation of papillary breast lesions and to identify histopathologic and imaging features that can possibly be used as predictors of malignancy.…”

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

et al. 2004

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The purpose of this study was to determine the accuracy of core needle biopsy (CNB) diagnosis of papillary breast lesions and to identify histologic features that can predict malignancy. We retrospectively reviewed 2876 CNB performed at MD Anderson Cancer Center (01/95-08/02) and identified 50 papillary lesions: 30 papillomas, eight atypical papillomas and 12 papillary carcinomas. Histopathological parameters were evaluated and radiographic findings were reviewed. When available, the CNB was compared with the excisional biopsy (EB) material. Carcinoma was confirmed by EB in 11/12 cases and invasion was correctly assessed in 67% of them. In EB, 6/8 (75%) atypical papillomas revealed carcinoma in situ or atypia and the remaining two (25%) were benign, six out of 30 (20%) papillomas had been excised and none had shown atypia; the remaining patients had clinical and radiological follow-up with no evidence of disease progression. We conclude that CNB is effective for assessing papillary breast lesions and that EB is more accurate in determining invasion. Cellular monotony, lack of myoepithelial cells, and cytologic atypia are more accurate predictors of malignancy (Po0.0001) than is the presence of mitoses (Po0.053). A diagnosis of carcinoma or atypical papilloma by CNB should warrant an EB, whereas benign papillomas may be followed if imaging findings are concordant.

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