Sonographic Differentiation of Benign and Malignant Papillary Lesions of the Breast

Kim, Tae Hee; Kang, Doo Kyoung; Kim, Sun Yong; Lee, Eun Ju; Jung, Yuh‐Seog; Yim, Hyunee

doi:10.7863/jum.2008.27.1.75

Cited by 54 publications

(52 citation statements)

References 8 publications

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“…A nonparallel orientation, echogenic halo, posterior acoustic enhancement, and associated microcalcification are reported to be more frequent in malignant lesions (10). Another study evaluating the role of clinicoradiological features in core biopsy proved that benign papillomas without atypia showed a higher postexcision upgrade for patients >50 years, lesions that were ≥1 cm, lesions that were ≥3 cm from the nipple, and lesions categorized as Breast Imaging-Reporting and Data System (BI-RADS) 4c and 5 (11).…”

Section: Differentiating Benign and Malignant Papillary Lesions On Immentioning

confidence: 99%

Papillary lesions of the breast: imaging findings and diagnostic challenges

Jagmohan

Pool²,

Putti³

et al. 2013

Diagn Interv Radiol

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Papillary breast lesions encompass a wide spectrum of pathologies ranging from benign lesions, such as solitary intraductal papilloma, to the uncommon papillary carcinoma. These lesions have various clinical presentations and diverse radiological features. Differentiating benign and malignant papillary lesions based on imaging features may often be difficult. Other benign and malignant pathologies can also mimic papillary lesions on imaging, and tissue diagnosis is essential. Imaging plays an important role in lesion identification, assessment of extent, tissue sampling, and follow-up. Surgical excision has been recommended for all papillary lesions due to an increased incidence of high-risk lesions and neoplasia even with percutaneous, biopsy-proven benign papillomas. This review looks at papillary breast lesions from the radiologists' standpoint and discusses the clinical, imaging, and pathological features of these lesions, as well as the role of imaging in their evaluation. P apillary lesions in the breast are uncommon but arise from a wide range of pathologies and have diverse clinical and imaging features. A papillary lesion is characterized by an arborescent structure composed of fibrovascular stalks covered by a layer of epithelial cells with or without an intervening myoepithelial cell layer (1). Overlapping features make differentiation of benign and malignant papillary lesions difficult on imaging, and a tissue diagnosis is essential. Definitive histopathologic diagnosis on core biopsy can occasionally be difficult. Additionally, even those lesions shown by percutaneous biopsy to be benign papillomas are associated with an increased likelihood of high-risk lesions and neoplasia. Due to nonspecific findings on imaging and histopathology, as well as varying malignant potential, papillary lesions present significant diagnostic and management challenges for the radiologists, pathologists, and surgeons. We briefly review the types of papillary lesions, multimodality imaging findings, and the radiologist's role in their evaluation. The types and clinical features of papillary lesionsPapillary lesions can be broadly categorized as benign or malignant. Benign papillary lesions include a solitary intraductal papilloma, multiple intraductal papillomas, and atypical ductal hyperplasia (ADH) within a papilloma. Malignant papillary lesions include ductal carcinoma in situ (DCIS) arising in a papilloma, papillary DCIS, intracystic or encapsulated papillary carcinoma, solid papillary carcinoma, invasive papillary carcinoma arising in an intracystic papillary carcinoma, and invasive papillary carcinoma (1). Intraductal papillomaSolitary papillomas arise from a large central duct, are more common in perimenopausal women, and present with nipple discharge. Multiple papillomas are peripheral lesions arising from the terminal duct lobular unit. These are less common, usually affect a younger age group, and present as a palpable mass. Both can be associated with proliferative and high-risk lesions, such as radial ...

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Section: Differentiating Benign and Malignant Papillary Lesions On Immentioning

confidence: 99%

Papillary lesions of the breast: imaging findings and diagnostic challenges

Jagmohan

Pool²,

Putti³

et al. 2013

Diagn Interv Radiol

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“…Ultrasonographically, a nonparallel orientation, an echogenic halo, posterior acoustic enhancement, and associated microcalcifications are more frequently found in intraductal papillary carcinomas when compared with benign papillomas. 18 The presence of any of these sonographic observations gives a sensitivity and specificity of 85.7% and 64.9%, respectively, for detection of malignant papillary lesions. There are no distinguishable macroscopic features.…”

Section: Papilloma With Adh and Papilloma With Dcismentioning

confidence: 98%

“…The only notable differential sonographic finding between noninvasive and invasive papillary carcinoma is a circumscribed margin. 18 It should be noted that an invasive nonpapillary carcinoma arising from encapsulated or solid papillary carcinoma should not be categorized as invasive papillary carcinoma. 52 Further, invasive micropapillary carcinoma should not be confused with invasive papillary carcinoma.…”

Section: Solid Papillary Carcinomamentioning

confidence: 99%

Papillary Lesions of the Breast: An Update

Wei

2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Papillary lesions of the breast, characterized by the presence of arborescent fibrovascular cores that support epithelial proliferation, constitute a heterogeneous group of neoplasms with overlapping clinical manifestation and histomorphologic features, but may have divergent biological behavior. These lesions are exclusively intraductal neoplasms, although an invasive carcinoma may rarely have a predominantly papillary architecture. Although recognition of a papillary architecture is typically not challenging, the histologic distinction of these entities is not always straightforward. Historically, different terminologies and variable criteria have been proposed for a given entity by various authorities. The difficulty in classifying these lesions has been further confounded by the scarcity of data and the heterogeneity across different studies with regard to the molecular genetic characteristics of this group of lesions. Objective.—To provide an overview focusing on the current concepts in the diagnosis and classification of papillary lesions of the breast incorporating recent molecular genetic advances. Data Sources.—Data were obtained from pertinent peer-reviewed English-language literature. Conclusions.—The recent evolution of molecular techniques has enhanced our knowledge of the pathogenesis of papillary carcinomas of the breast. This, along with emerging outcome studies, has led to prognosis-based reclassification of some of these entities. Additional studies focusing on the molecular signatures are needed to identify potential decision tools to further stratify these lesions with respect to prognostic significance.

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“…Mammography can show a small, circumscribed subareolar mass, rarerly with associated calcifications or a solitary dilated retroareolar duct but, in most cases, the lesion is occult on mammography. On ultrasound, a solitary papilloma appears as a dilated duct with a hipoechoic content, as a parenchimal profliferation inside a dilated duct [10] or as a solid mass with well defined borders [1,7,9,11] (fig 6). Doppler ultrasound and elastography, by showing the presence of blood vessels inside the intraductal content (fig 7) or the stifness vs BGR sign specific for fluid filled lesions, can differentiate intraductal lesions by apocrine metaplasia or dilated ducts with viscous content (fig 8-10).…”

Section: Benign Papillary Lesionsmentioning

confidence: 99%

“…It is important, when suspecting a papillary lesion, to keep in mind that benign and malignant lesions have overlapping features and even if ultrasound can rise or infirm the suspicion of malignancy, the final diagnosis is based on core or excisional biopsy [9].…”

Section: (Fig 5)mentioning

confidence: 99%

Ultrasound in the diagnosis of papillary breast lesions

Ciurea

Calin²,

Ciortea³

et al. 2015

Med Ultrason

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Papillary lesions are defined as an amalgam of various lesions which represent a diagnostic challenge, for both the radiologist and pathologist. They are diagnosed on the basis of a combination of clinical, imaging, and pathological findings and their features carry differing prognostic implications for the affected patients. The aim of this pictorial essay is to review the clinical and pathological findings in papillary breast lesions, to show the advantages and limits of each imaging method in their diagnosis with emphasis on the importance of ultrasound in the differential diagnosis. Also, the spectrum of ultrasound features (conventional, Doppler ultrasound and elastography) of papillary lesions of the breast will be illustrated.

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Sonographic Differentiation of Benign and Malignant Papillary Lesions of the Breast

Abstract: Sonographic features more specific to malignancy include a nonparallel orientation, an echogenic halo, posterior acoustic enhancement, and associated microcalcification.

Cited by 54 publications

References 8 publications

Papillary lesions of the breast: imaging findings and diagnostic challenges

Papillary lesions of the breast: imaging findings and diagnostic challenges

Papillary Lesions of the Breast: An Update

Ultrasound in the diagnosis of papillary breast lesions

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