Benign papilloma diagnosed on image-guided 14 G core biopsy of the breast: Effect of lesion type on likelihood of malignancy at excision

One-hundred-fourteen consecutive cases of breast ultrasound-guided 14-gauge needle core biopsy (14G NCB) performed from January 2001 to June 2013 and diagnosed as non-malignant papillary lesion (PL)-B3, were reviewed and compared with definitive histological diagnosis on surgical excision (SE) to evaluate the diagnostic accuracy of ultrasound-guided 14G NCB. PL with epithelial atypia on 14G NCB were associated to malignancy on definitive histological diagnosis on SE in 22 (7 DCIS and 15 invasive carcinomas) of 46 cases with an underestimation rate of 47.8 %, while 9 (4 DCIS and 5 invasive carcinomas) cases out of 68 cases of PL without epithelial atypia were upgraded to carcinoma with an underestimation rate of 13.2 %. In cases of PL with epithelial atypia on ultrasound-guided 14G NCB, SE appears mandatory due to the high risk of associated malignancy. The diagnosis of PL without epithelial atypia on ultrasound-guided 14G NCB does not exclude malignancy at subsequent SE, consequently further assessment (by surgical or vacuum-assisted excision) is recommended to avoid the risk of delaying a diagnosis of malignancy, although this tends to be lower (1 in 8 patients).

show abstract

“…This may result in failure to sample an area of malignancy, resulting in under-diagnosis of the lesion [6].…”

Section: Discussionmentioning

confidence: 99%

Non-Malignant Breast Papillary Lesions - B3 Diagnosed on Ultrasound - Guided 14-Gauge Needle Core Biopsy: Analysis of 114 Cases from a Single Institution and Review of the Literature

Bianchi

Bendinelli

Saladino

et al. 2015

Pathol. Oncol. Res.

View full text Add to dashboard Cite

show abstract

“…Meanwhile, some studies showed a statistical association of upgrades with similar variables. 9,15,17,19,27,30,31,36,43,[45][46][47] In a study by Youk et al, 46 8 (5.0%) of 160 papillomas at US-guided 14-gauge CNB were upgraded to malignancy, and imaging-histologic discordance, patient age (≥50 years), lesion size (≥1 cm), lesion distance from the nipple (≥3 cm), and BI-RADS category were helpful in predicting the possibility of an upgrade to malignancy. Two other studies 43,47 reported that lesions smaller than 1.5 cm had statistically significantly lower upgrade rates.…”

Section: Discussionmentioning

confidence: 99%

“…This lack of consensus is mainly based on the highly variable upgrade rates for CNB after surgical excision or imaging follow‐up 6 – 47 . However, recently, a number of studies have suggested that surgical excision is not warranted for benign papillomas diagnosed at vacuum‐assisted biopsy, 13 , 33 , 34 – 39 or for some selected cases 40 – 45 …”

mentioning

confidence: 99%

“…However, recently, a number of studies have suggested that surgical excision is not warranted for benign papillomas diagnosed at vacuumassisted biopsy, 13,33,[34][35][36][37][38][39] or for some selected cases. [40][41][42][43][44][45] As whole-breast ultrasound (US) has been increasingly used for screening and diagnostic examinations, asymptomatic and mammographically occult papillary lesions of the breast have been detected with increasing frequency. Even though the steps for management of benign papillary lesions incidentally detected on US must be considered, to the best of our knowledge, there is only one published English study addressing this issue.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Management of Clinically and Mammographically Occult Benign Papillary Lesions Diagnosed at Ultrasound‐Guided 14‐Gauge Breast Core Needle Biopsy

Moon

Jung

et al. 2016

J of Ultrasound Medicine

View full text Add to dashboard Cite

show abstract

“…22,51,58 VAB has also gained recognition lately as an approach to manage patients after BPs without atypia are diagnosed on automated needle biopsy specimens, hence sparing a subset of patients from surgery. 47,54,59–62 Experience is still accumulating in this regard.…”

Section: Discussionmentioning

confidence: 99%

Benign Papillomas Without Atypia Diagnosed on Core Needle Biopsy: Experience From a Single Institution and Proposed Criteria for Excision

Nayak

Çarkaci

Gilcrease

et al. 2013

Clinical Breast Cancer

View full text Add to dashboard Cite

The management of benign papilloma (BP) without atypia identified on breast core needle biopsy (CNB) is controversial. We describe the clinicopathologic features of 80 patients with such lesions in our institution, with an upgrade rate to malignancy of 3.8%. A multidisciplinary approach to select patients for surgical excision is recommended. Background The management of benign papilloma (BP) without atypia identified on breast core needle biopsy (CNB) is controversial. In this study, we determined the upgrade rate to malignancy for BPs without atypia diagnosed on CNB and whether there are factors associated with upgrade. Methods Through our pathology database search, we studied 80 BPs without atypia identified on CNB from 80 patients from 1997 to 2010, including 30 lesions that had undergone excision and 50 lesions that had undergone ≥ 2 years of radiologic follow-up. Associations between surgery or upgrade to malignancy and clinical, radiologic, and pathologic features were analyzed. Results Mass lesions, lesions sampled by ultrasound-guided CNB, and palpable lesions were associated with surgical excision. All 3 upgraded cases were mass lesions sampled by ultrasound-guided CNB. None of the lesions with radiologic follow-up only were upgraded to malignancy. The overall upgrade rate was 3.8%. None of the clinical, radiologic, or histologic features were predictive of upgrade. Conclusion Because the majority of patients can be safely managed with radiologic surveillance, a selective approach for surgical excision is recommended. Our proposed criteria for excision include pathologic/radiologic discordance or sampling by ultrasound-guided CNB without vacuum assistance when the patient is symptomatic or lesion size is ≥ 1.5 cm.

show abstract

Benign papilloma diagnosed on image-guided 14 G core biopsy of the breast: Effect of lesion type on likelihood of malignancy at excision

Cited by 11 publications

References 36 publications

Non-Malignant Breast Papillary Lesions - B3 Diagnosed on Ultrasound - Guided 14-Gauge Needle Core Biopsy: Analysis of 114 Cases from a Single Institution and Review of the Literature

Non-Malignant Breast Papillary Lesions - B3 Diagnosed on Ultrasound - Guided 14-Gauge Needle Core Biopsy: Analysis of 114 Cases from a Single Institution and Review of the Literature

Management of Clinically and Mammographically Occult Benign Papillary Lesions Diagnosed at Ultrasound‐Guided 14‐Gauge Breast Core Needle Biopsy

Benign Papillomas Without Atypia Diagnosed on Core Needle Biopsy: Experience From a Single Institution and Proposed Criteria for Excision

Contact Info

Product

Resources

About