Benign Papillomas of the Breast Diagnosed on Large-Gauge Vacuum Biopsy compared with 14 Gauge Core Needle Biopsy - Do they require surgical excision?

Seely, Jean M.; Verma, Raman; Kielar, Ania Z.; Smyth, Karl R.; Hack, Kalesha; Taljaard, Monica; Gravel, Denis; Ellison, Erin

doi:10.1111/tbj.12702

Cited by 33 publications

(21 citation statements)

References 44 publications

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“…50% No association with age and size lesion Ko et al 2017 [ 63 ] n = 346 PL in CNB Upgrade In VAB ( n = 211) In OE ( n = 135) Upgrade Overall in 2.3% If size < 1cm: 0.9% Size of PL correlates with upgrade Close follow-up with ultrasound instead of excision Moon et al 2016 [ 64 ] n = 65 PL in CNB Upgrade In VAB ( n = 12) In OE ( n = 53) Upgrade In OE in 9% (5/53) In VAB 8% (1/12) No recommendation Niinikoski et al 2018 [ 65 ] n = 80 PL in CNB Small PL in selected patients-OE can be avoided Pareja et al. 2016 [ 66 ] Upgrade in OE ( n = 171) after PL Without atypia In CNB Upgrade In OE 2.3% (4/171) Regardless of size, observation is appropriate at radiologic–pathologic concordant CNB Seely et al 2017 [ 67 ] n = 107 PL in OE Upgrade after VAB ( n = 60) CNB ( n = 47) Upgrade in OE After VAB in 1.6% (1/60) After CNB in 8.5% (4/47) Higher upgrade in OE if PL is diagnosed on CNB Tatarian et al 2016 [ 68 ] n = 16 PL in CNB Upgrade in OE Upgrade in OE In 2/16 cases (12.5%) Surgical excision should be considered in patients with benign papillomas Tran et al 2017 [ 69 ] n = 43 PL in CNB Upgrade in OE Upgrade in OE In 1/43 cases (2%) Low-upgrade rate in OE Wyss et al 2014 [ 70 ] …”

Section: Resultsmentioning

confidence: 99%

Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Rageth

O’Flynn

Pinker

et al. 2018

Breast Cancer Res Treat

203

261

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Purpose The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the consensus recommendations. Methods This study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy. Results In 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN [65% in 2018 vs. 51% in 2016 ( p = 0.004)], FEA (72% in 2018 vs. 62% in 2016 ( p = 0.005)), and PL [(76% in 2018 vs. 70% in 2016 ( p = 0.04)] diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS [77% in 2018 vs. 67% in 2016 ( p = 0.07)]. Conclusions Minimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN.

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Section: Resultsmentioning

confidence: 99%

Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Rageth

O’Flynn

Pinker

et al. 2018

Breast Cancer Res Treat

203

261

View full text Add to dashboard Cite

show abstract

“…Therefore, the management of benign IDPs diagnosed by CNB remains controversial. Several studies have shown that the upgrading rate after open excision is associated with the adequacy of samples in biopsy lesions, even though the needle gauge used in CNB plays an important role in upgrading the rate of IDP [15,16]. In our study, we found an underestimation of 2/26 (7.7%) following open excision after VAE.…”

Section: Discussioncontrasting

confidence: 50%

Breast papillary lesions diagnosed and treated using ultrasound-guided vacuum-assisted excision

Gao

et al. 2020

BMC Surg

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Background The management of papillary lesions of the breast remains controversial, and thus, we assessed the value of vacuum-assisted excision (VAE)-guided ultrasound in the diagnosis and treatment of breast papillary lesions. Methods We retrospectively reviewed the data of 108 patients with papillary lesions diagnosed using VAE between August 2014 and January 2019. Cases without postoperative breast imaging in the follow-up were excluded, and 85 cases were eligible for the study. The follow-up period ranged from 6 to 53 months, with 38 months on average. All the papillary lesions were located away from the skin or nipple with a size less than or equal to 30 mm, and the lesions categorized as C2-4b were completely excised using VAE. All VAEs were performed using an 8-gauge vacuum-assisted biopsy needle under the guidance of ultrasound using a 10 MHz linear probe. Results Most patients with breast papillary lesions were asymptomatic (56.5%), and when the size of the breast papillary lesion was more than 20 mm on ultrasound imaging, atypical hyperplasia may have been concomitant. Breast lesions might have been pathologically diagnosed as papilloma after biopsy when they were categorized as BI-RADS 4a on ultrasound images. The rate of underestimation was 7.7% in papillary lesions diagnosed with VAE, and the recurrence rate of papilloma after VAE was low. Conclusions Breast papilloma was a common lesion on ultrasonographic screening, and VAE was applicable for completely excising small papillomas, even papillomas with atypical hyperplasia, to obtain an accurate diagnosis with a low rate of underestimation and recurrence. We believe that papilloma diagnosed by VAE might not require immediate excision, and imaging follow-up may be safe for at least 3 years.

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“…In such cases, T2‐hypo‐rim may indicate the possibility that the lesion is intraductal/intracystic. Furthermore, papillary lesions are often difficult to correctly diagnose by the analysis of small‐volume histopathologic specimens, particularly those obtained by small‐gauge CNB . Maxwell et al reported that 11 (11%) of 96 lesions with a 14‐gauge CNB diagnosis of benign papilloma without atypia were upgraded to atypia or malignancy after subsequent lesion excision by either VAB or surgery.…”

Section: Discussionmentioning

confidence: 99%

T2-hypointense rim of breast mass lesions on magnetic resonance images: Radiologic-pathologic correlation

et al. 2018

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We investigated the radiologic-pathologic correlation of a strong hypointense rim on T2-weighted images (T2-hypo-rim) surrounding breast mass lesions and evaluated its clinical significance. We retrospectively reviewed 3503 consecutive breast magnetic resonance imaging (MRI) examinations. The T2-hypo-rim was defined as a border of strong hypointensity compared with the fat signal on fat-suppressed T2-weighted images. Detected lesions with T2-hypo-rim were classified as a solid or cystic mass with MRI and correlated with histopathologic findings. Sixty-two masses (2%; 34 solid, 28 cystic) with T2-hypo-rim were detected [44 breast cancers, 18 benign lesions, including 15 (24%) papillary tumors]. Patients with cancer were significantly older than those with benign lesions (P = .002). Breast cancers were significantly larger than benign masses (P = .023). In 49 of 62 lesions (24 solid and 16 cystic cancers; three solid and six cystic benign masses), the rims were accurately correlated with the histopathologic findings. All malignant and benign cystic masses exhibited hemosiderin deposits in the cyst walls. However, 22 of 24 solid cancers and no solid benign masses exhibited hemosiderin at the tumor periphery (92% and 0%, respectively, P < .001). In addition, a thick fibrous capsule was present in nine (38%) of 24 solid cancers and none of the solid benign lesions. Strong T2-hypo-rims mostly correlated with hemosiderin deposits and/or sometimes fibrous capsules. Although the rims could not distinguish malignant from benign cystic lesions, they indicated malignancy in solid mass lesions on MRI. Additionally, the rims often indicated papillary tumors.

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Benign Papillomas of the Breast Diagnosed on Large-Gauge Vacuum Biopsy compared with 14 Gauge Core Needle Biopsy - Do they require surgical excision?

Cited by 33 publications

References 44 publications

Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Breast papillary lesions diagnosed and treated using ultrasound-guided vacuum-assisted excision

T2-hypointense rim of breast mass lesions on magnetic resonance images: Radiologic-pathologic correlation

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