Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up

Bernik, Stephanie F.; Troob, Scott H.; Ying, B; Simpson, Scott A.; Axelrod, Deborah; Siegel, Beth; Moncrief, Robyn M.; Mills, Christopher; Aziz, Mohamed

doi:10.1016/j.amjsurg.2008.04.007

Cited by 71 publications

(42 citation statements)

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“…These studies reported their rates of upgrade from benignity on core needle biopsy to malignancy and papilloma with atypia after surgical excision. 1,5,[7][8][9]11,15,16,25,28,29,[31][32][33][34][35][36] Our finding was within the range of the reported upgrade rate to papilloma with atypia. Age data are reported as mean ± SD (median, range).…”

Section: Discussionsupporting

confidence: 70%

“…Moreover, prior studies have shown that papillomas with atypia diagnosed at core needle biopsy were more often upgraded histologically to malignancy than benign papillomas after surgical excision. [2][3][4][5][6][10][11][12][13]25,33,34,38 Some studies reported atypical papilloma as a generalized risk factor for the development of breast cancer. [39][40][41] Therefore, surgical excision has been recommended as a management strategy for atypical papillomas at core needle biopsy.…”

Section: Sohn and Park-sonographically Guided Core Needle Biopsy And mentioning

confidence: 99%

“…In addition, the classification of atypical papillomas depends on the percentage (>33%) 37 or size (>3mm) 38 of the lesion, atypical epithelial proliferation, and the presence or absence of an intact myoepithelial cell layer; usually, the area of atypia is limited to a small area. Bernik et al 5 asserted that there is a strong likelihood of discovering atypia or malignancy in the index lesion or in close proximity to it after surgical excision of a papillary lesion by core needle biopsy; therefore, surgical excision should be performed to avoid missing a malignancy and to ensure an accurate diagnosis. Moreover, prior studies have shown that papillomas with atypia diagnosed at core needle biopsy were more often upgraded histologically to malignancy than benign papillomas after surgical excision.…”

Section: Sohn and Park-sonographically Guided Core Needle Biopsy And mentioning

confidence: 99%

“…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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confidence: 99%

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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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Section: Discussionsupporting

confidence: 70%

Section: Sohn and Park-sonographically Guided Core Needle Biopsy And mentioning

confidence: 99%

Section: Sohn and Park-sonographically Guided Core Needle Biopsy And mentioning

confidence: 99%

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confidence: 99%

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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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“…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%