The management of papillary lesion of the breast by core needle biopsy

Tseng, Hsin-Shun; Chen, Y.L.; Chen, S.T.; Wu, Yu-Shiang; Kuo, Shou‐Jen; Chen, L.S.; Wu, Hwa-Koon; Chen, D.R.

doi:10.1016/j.ejso.2008.06.004

Cited by 59 publications

(46 citation statements)

References 16 publications

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“…4,6,7,[9][10][11] This approach, however, results in overtreatment of many women as the small increase in cancer risk associated with a single-benign papilloma is analogous to that of usual ductal hyperplasia. 12 There have been a number of attempts to develop ancillary methods that may improve the diagnostic accuracy of papillary lesion assessment on core biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The rate of underdiagnosis of atypia or malignancy following a core biopsy diagnosis of benign papilloma is 420% in some reports. [3][4][5][6][7] Consequently, excision is generally recommended to establish a definitive diagnosis for asymptomatic papillary lesions that are diagnosed on core biopsy following mammographic detection. However, an accurate core biopsy prediction of the final diagnostic category would provide a useful guide to management and may allow further surgery to be avoided for some patients.…”

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Diagnostic evaluation of papillary lesions of the breast on core biopsy

et al. 2010

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Diagnostic evaluation of papillary lesions of the breast on core biopsy

et al. 2010

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“…Reported upgrading rates from benign papillary lesions diagnosed by CNB to malignant papillary lesions diagnosed on subsequent surgical excision range from 0% to 29% (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Some investigators have suggested that benign papillary lesions without atypia diagnosed by CNB, in combination with concordant imaging findings, can be safely followed without further surgery (2-7).…”

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confidence: 99%

“…Some investigators have suggested that benign papillary lesions without atypia diagnosed by CNB, in combination with concordant imaging findings, can be safely followed without further surgery (2-7). However, many recent studies advocate the complete excision of any papillary lesion diagnosed by CNB (1,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

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Upgrading rate of papillary breast lesions diagnosed by core-needle biopsy

Wiratkapun

Keeratitragoon²,

Lertsithichai³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to estimate the upgrading rate of core-needle biopsy (CNB)-diagnosed papillary breast lesions to atypical or malignant papillary lesions on subsequent surgery. MATERIALS AND METHODSWe performed a retrospective review of medical records and imaging findings of patients diagnosed by CNB as having papillary lesions from January 1, 2005 to May 31, 2011. Outcomes were determined by pathology findings from surgical excision or by imaging findings at 12 months follow-up. RESULTSOf 130 papillary lesions in 127 patients, the upgrading rates were 0% for benign papillary lesion to malignancy, 19% for benign papillary lesion to atypical papillary lesion, and 31% for atypical lesion to malignancy. Most of the malignancies were ductal carcinoma in situ. The presence of malignant lesions was related to specific symptoms (palpable mass or nipple discharge; P = 0.020) and to a higher Breast Imaging Reporting and Data System (BIRADS) category (P = 0.017). CONCLUSION CNB is accurate in the diagnosis of benign papillary lesions. If no atypical cells are present, no malignancy is found. The presence of atypia on CNB strongly indicates a need for surgical excision.

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“…3 However, there have been a number of controversies regarding management with subsequent surgical excision in benign papillomas without atypia after core needle biopsy. 1,2,[4][5][6][7][8][9][10][11][12] Some recent investigators have suggested the use of selective surgical excision for benign papillomas without atypia after considering clinical and radiologic factors or supported conservative management. 4,7,[13][14][15][16][17][18] Prediction of clinical and radiologic factors associated with an upgrade to atypia or malignancy will be very helpful for both clinicians and radiologists.…”

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

Sohn

2013

Journal of Ultrasound in Medicine

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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.

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The management of papillary lesion of the breast by core needle biopsy

Cited by 59 publications

References 16 publications

Diagnostic evaluation of papillary lesions of the breast on core biopsy

Diagnostic evaluation of papillary lesions of the breast on core biopsy

Upgrading rate of papillary breast lesions diagnosed by core-needle biopsy

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

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