Underestimation of the Presence of Breast Carcinoma in Papillary Lesions Initially Diagnosed at Core-Needle Biopsy

Sydnor, M.K.; Wilson, John D.; Hijaz, Tarek A.; Massey, Helen; Paredes, Ellen S Shaw de

doi:10.1148/radiol.2421031988

Cited by 174 publications

(133 citation statements)

References 15 publications

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“…The location of the papillary lesion is another widely studied risk factor. Some studies reported a tendency for the papillary lesion to be malignant if it was located at the periphery of the breast (19,20), whereas no such association was found in many other studies, including the present study (3,6,8).…”

Section: Discussioncontrasting

confidence: 80%

“…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%

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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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Section: Discussioncontrasting

confidence: 80%

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confidence: 99%

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

Wiratkapun

Keeratitragoon²,

Lertsithichai³

et al. 2013

Diagn Interv Radiol

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“…However, papillary lesions associated with epithelial atypia require surgical excision for definitive diagnosis because histologic underestimation occurs at a frequency similar to that in other atypical lesions undergoing NCB. 31,32,34,35 Although only one lesion diagnosed as cellular fibroepithelial lesion on core was malignant on excision, 36.5% were phyllodes tumors.…”

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confidence: 99%

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Rakha

Lee

Jenkins

et al. 2011

Intl Journal of Cancer

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In the setting of breast cancer screening, 5-9% of needle core biopsies are diagnosed as lesions of uncertain malignant potential (B3). The management of these lesions is potentially problematic as the data on their outcome remains limited. In our study, we aim to assess the outcome of screen-detected lesions diagnosed as B3 in a large series to validate previous studies and to characterize the malignant lesions detected after a B3 diagnosis. Therefore, the results of 1,025 needle core biopsies of women screened over a 7-year period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) in two different regions in the UK with B3 diagnoses who underwent surgical excision were reviewed and compared to the final excision histology. Final histology showed that 25% of cases were malignant (17% ductal carcinoma in situ and 8% invasive). Predictors of malignancy included calcification on imaging and epithelial atypia on needle core biopsy particularly atypical ductal hyperplasia [positive predictive value 50%]. Pure flat epithelial atypia showed the lowest positive predictive value amongst all epithelial atypia groups (21%). The positive predictive value was low for complex sclerosing lesions (9%) and papillary lesions (13%) without epithelial atypia. Malignant tumors detected after B3 diagnosis showed favorable histological features, the majority were in situ, and most belonged to the low grade breast neoplasia family that is associated with indolent behavior. The underlying radiological abnormality was calcification in 44% of cases and the imaging classification was malignant/suspicious in 38%. In conclusion, our results further emphasize the heterogeneity of B3 lesions and that the likelihood of malignancy varies substantially between different histological subtypes. Malignancy is particularly associated with epithelial atypia suggesting the use of two categories of with and without epithelial atypia. Radiological findings provided useful information regarding the nature and outcome of B3 lesions.

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“…So, when a definitive diagnosis of malignancy cannot be done because of discordant findings, sampling limitations of a core biopsy 5 or open biopsy, or limited sensibility of breast images, 5,6 resection of the entire lesion is mandatory [1][2][3][4]6 due to high association with malignancy. 1,2,4 The open biopsy was an attempt to improve the pathological results that were hindered by limitation of diagnostic procedures and discordant findings. Also, the indication for diagnostic mastectomy, 7 as seen in this case, is a fact that must be thoroughly discussed with the patient.…”

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confidence: 99%