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

Moon, Sung Mo; Jung, Haejoon; Ko, Kyung Hee; Kim, Youdong; Lee, Kyong Sik

doi:10.7863/ultra.15.11049

Cited by 10 publications

(9 citation statements)

References 49 publications

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“…Moon et al ., reported that clinically occult benign papillary BLs diagnosed benign at US-guided 14-gauge CNB are not uniformly managed by surgical excision and the short-term follow-up is unnecessary. [2728] Our results also consistent with the results of Rikabi and Husaain who reported 98.2% diagnostic accuracy for tru-cut biopsy (CNB) but he reported the use of 18-gauge needle. [29]…”

Section: Discussionsupporting

confidence: 90%

Predictive value of ultrasound imaging in differentiating benign from malignant breast lesions taking biopsy results as the standard

Binnuhaid

Alshoabi

Alhazmi

et al. 2019

J Family Med Prim Care

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Background:Breast lesions (BLs) are abnormal swellings within the breast. The importance lies in need to exclude breast cancer.Objective:Due to the role of ultrasound (US) imaging in evaluating of BLs, this study was conducted to evaluate the predictive value of US imaging for differentiating benign from malignant BLs and to assess the need of biopsy in BLs.Method:A retrospective review of diagnostic results of 134 patients with BLs. All patients underwent breast US imaging and US-guided biopsy for cytology or histopathology. The results of both were compared.Results:Out of 134 patients were included in this study, the mean age was 38.45 ± 15.82 years (range, 18–90 years), and all patients were female. BLs were benign in 99 cases (73.9%) and malignant in 35 cases (26.1%). Among 98 patients with BLs diagnosed benign with US, 96.9% were confirmed benign with biopsy results and only 3.1% were malignant. The overall sensitivity of US imaging for discriminating of benign BLs was 95.95%, with a specificity of 91.42%, and positive predictive value of 96.94%. The results revealed strong compatibility between diagnoses by US imaging and biopsy results (P < 0.001), the measure of agreement kappa = 0.866, and the Spearman's correlation coefficient = 0.866.Conclusion:US imaging is a highly valuable imaging method in differentiating benign from malignant BLs. It usually predicts the benign nature of BLs with excellent diagnostic accuracy. US-guided fine-needle aspiration and core-needle biopsies are not necessary in most cases of BLs.

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Section: Discussionsupporting

confidence: 90%

Predictive value of ultrasound imaging in differentiating benign from malignant breast lesions taking biopsy results as the standard

Binnuhaid

Alshoabi

Alhazmi

et al. 2019

J Family Med Prim Care

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“…1.8% BI-RADS 4b-5: 13% resp. 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%

“…1.8%BI-RADS 4b-5: 13% resp. 50%No association with age and size lesionKo et al 2017 [63] n = 346 PL in CNBUpgradeIn VAB ( n = 211)In OE ( n = 135)UpgradeOverall in 2.3%If size < 1cm: 0.9%Size of PL correlates with upgradeClose follow-up with ultrasound instead of excisionMoon et al 2016 [64] n = 65 PL in CNBUpgradeIn VAB ( n = 12)In OE ( n = 53)UpgradeIn OE in 9% (5/53)In VAB 8% (1/12)No recommendationNiinikoski et al 2018 [65] n = 80 PL in CNBSmall PL in selected patients-OE can be avoidedPareja et al. 2016 [66]Upgrade in OE ( n = 171) after PL Without atypiaIn CNBUpgradeIn OE 2.3% (4/171)Regardless of size, observation is appropriate at radiologic–pathologic concordant CNBSeely et al 2017 [67] n = 107 PL in OEUpgrade afterVAB ( n = 60)CNB ( n = 47)Upgrade in OEAfter VAB in 1.6% (1/60)After CNB in 8.5% (4/47)Higher upgrade in OE if PL is diagnosed on CNBTatarian et al 2016 [68] n = 16 PL in CNBUpgrade in OEUpgrade in OEIn 2/16 cases (12.5%)Surgical excision should be considered in patients with benign papillomasTran et al 2017 [69] n = 43 PL in CNBUpgrade in OEUpgrade in OEIn 1/43 cases (2%)Low-upgrade rate in OEWyss et al 2014 [70] n = 156 PL in CNBUpgradeIn VAB ( n = 135) andFollow-up ( n = 21)(Median 3.5 years)Upgrade after follow-up1.2% (2/156)VAB is recommended as the method of choice for removal of PLYamaguchi et al 2015 [71] n = 142 PLFollow-up imagingAfter VAB ( n = 125)After CNB ( n = 17)Upgrade in OE ( n = 17)4/17Discordant lesions should undergo OEYang et al 2018 [72] n = 116 PL(On CNB or VAB)10 mm or smallerOE n = 74Surveillance n = 42Overall upgrade 11% (13/116)Upgrade after VAB (0%)Upgrade after CNB (16.5%)Higher upgrade in OE-After CNB-Older age-Pl with atypia…”

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

205

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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“…Papillary breast lesions represent approximately 4.5% to 10.7% of the breast lesions diagnosed on core needle biopsy (CNB) and vacuum-assisted biopsy. [3][4][5] Their clinical presentations can be either asymptomatic, bloody nipple discharges, or palpable masses depending on the location and size. The radiographic findings include calcifications or solid/cystic mass lesions.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Papillary Breast Lesions on Core Needle Biopsy: Upgrade Rates and Interobserver Variability

Qiu

Mais

Nicolas³

et al. 2019

Int J Surg Pathol

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The histologic distinction between papillary breast lesions remains challenging, especially with core biopsy (CB) specimens. A retrospective review of the clinical, imaging, and histologic findings was performed for patients with papillary breast lesions on CB from 2013 to 2017. The interpretation accuracy was expressed as upgrade rate relative to the excision diagnosis. Diagnostic reproducibility with and without immunohistochemistry was analyzed as interobserver variability among 3 board-certified pathologists. Among 57 papillary lesions with biopsies and excisions available for review, the upgrade rates were 0% for benign papilloma, 30% for papilloma with atypical ductal hyperplasia, and 25% for papilloma with ductal carcinoma in situ, resulting in an overall upgrade rate of 11.1%. There were no statistical differences between patients in an upgrade group and others, when comparing the patient age, clinical presentation, BI-RADS (Breast Imaging Reporting and Database System) category, location, and histologic grade. The overall interobserver variability of the 60 consecutive core biopsies of papillary breast lesions by morphology alone was in the “substantial” agreement range (κ = 0.79, 86% agreement), with an excellent κ score of 0.88 for papilloma (92% agreement). “Substantial” and “fair” κ values were seen for papilloma with atypical ductal hyperplasia/ductal carcinoma in situ (0.74, 84% agreement) and invasive carcinoma (0.40, 60% agreement). Use of immunohistochemical stains improved the κ values into “excellent” range (0.92, 94% agreement). Our study favors a conservative approach in the management of benign papillomas, at least in cases of good radiologic-pathologic concordance. Papillary breast lesions with atypia/malignancy show lower diagnostic reproducibility on CB, and utility of immunohistochemistry is recommended in challenging cases.

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

Cited by 10 publications

References 49 publications

Predictive value of ultrasound imaging in differentiating benign from malignant breast lesions taking biopsy results as the standard

Predictive value of ultrasound imaging in differentiating benign from malignant breast lesions taking biopsy results as the standard

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

Diagnosis of Papillary Breast Lesions on Core Needle Biopsy: Upgrade Rates and Interobserver Variability

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