Papillary Lesions of the Breast: Evaluation with Stereotactic Directional Vacuum-assisted Biopsy

Mercado, Cecilia L.; Hamele‐Bena, Diane; Singer, Cory; Koenigsberg, Tova; Pile-Spellman, Eliza; Higgins, Helen; Smith, Suzanne J.

doi:10.1148/radiol.2213010005

Cited by 124 publications

(79 citation statements)

References 13 publications

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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: 84%

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: 84%

Comparison of Sonographically Guided Core Needle Biopsy and Excision in Breast Papillomas

Sohn

2013

Journal of Ultrasound in Medicine

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“…Of the 104 cases, 30 were mammotome core needle biopsies, all done for calcifications (14-gauge) and 74 were ultrasound-guided (16-, 18-, or 20-gauge). The average number of ultrasound-guided core cylinders obtained per patient was 5 (range, [3][4][5][6][7][8][9][10][11][12]; for mammotome core needle biopsy it was 15 (range, [10][11][12][13][14][15][16][17][18][19][20]. The diagnoses on the excision specimens were as follows: no residual intraductal papillomas, 16 (15.3%); residual intraductal papillomas, 71 (68.3%); atypical duct hyperplasia, 8 (7.7%); ductal carcinoma in situ, 6 (5.8%); and invasive carcinoma, 3 (2.9%).…”

Section: Resultsmentioning

confidence: 99%

“…Early studies indicated that patients diagnosed with intraductal papillomas on core needle biopsy had a small but definite chance of atypia (15% to 37.5%) or malignancy (15% to 17%) on excision. [7][8][9][10][11] Numerous other series failed to support these findings [3][4][5]12 advocating mammographic follow-up rather than excision. Many of these studies were small in number and had potential selection bias.…”

Section: Discussionmentioning

confidence: 99%

“…1,6 Earlier series attempting to resolve these issues indicated a small but definite risk for atypia (15%-37.5%) or malignancy (15%-17%). [7][8][9][10][11] Initially, some studies failed to find any atypia or malignancy when pure intraductal papillomas were excised [3][4][5]12 and thus advocated against excision. However, more recent series recommend excision because of upstaging of these lesions on excision.…”

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confidence: 99%

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Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy

Jaffer

Nagi

Bleiweiss

2009

Cancer

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BACKGROUND: Although it has been accepted that intraductal papillomas with atypia or malignancy diagnosed on core needle biopsy require surgical excision, the management of pure intraductal papillomas has been controversial. Because some series reported a small but definite incidence of atypia or malignancy, whereas others claimed that radiologic follow‐up was adequate, this study evaluated results of excision of all pure intraductal papillomas diagnosed on core needle biopsy at this institution. METHODS: By using computerized pathology files from January of 2000 to December of 2004, 200 cases of intraductal papillomas on core needle biopsy were identified. Information regarding excision was available in 104 cases. All specimens were reviewed to confirm both the diagnoses as well as the presence of biopsy site changes in excision specimens, and the findings were correlated with radiologic data. RESULTS: The age of the patients ranged from 25 to 82 years (mean, 55.5). The diagnoses on excision were as follows: intraductal papillomas = 71 cases (68.3%), no residual intraductal papillomas = 16 (15.3%), atypical duct hyperplasia = 8 (7.7%), ductal carcinoma in situ = 6 (5.8%), and invasive carcinoma = 3 (2.9%). In cases with atypia or malignancy, these findings were adjacent to but not in the biopsy site. In cases with atypical duct hyperplasia or ductal carcinoma in situ, a spectrum of histologic changes ranging from florid to atypical duct hyperplasia (14 cases), to ductal carcinoma in situ (6 cases) were present, all involving intraductal papillomas. CONCLUSIONS: The upstage rate of pure intraductal papillomas on core needle biopsy to atypia or malignancy on excision was 16.4%. Because of sampling error and the close proximity of atypia or malignancy to the intraductal papillomas (suggesting precancerous potential), excision was recommended of these lesions diagnosed on core needle biopsy. Close radiologic‐pathologic correlation was important in the evaluation of these lesions. Cancer 2009. © 2009 American Cancer Society.

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“…Choice of biopsy device depended largely on the preference of the radiologist performing the biopsy, although the preferences of the physician and patient also affected this decision. The vacuum-assisted biopsy device was preferred for lesions where it may have been particularly beneficial [16][17][18], such as calcified lesions, intraductal lesions and solid nodules with irregular margins. Automated gun biopsy was preferred for multifocal and subareolar lesions.…”

Section: Ultrasound-guided Biopsymentioning

confidence: 99%

Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy

Han

Lee

et al. 2007

Breast Cancer Res Treat

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Background The aim of this study was to determine factors that predict under-evaluation of malignancy in patients diagnosed with atypical ductal hyperplasia (ADH) at ultrasound-guided core needle biopsy (CNB), and to develop a prediction algorithm for scoring the possibility of a diagnosis upgrade to malignancy based on clinical, radiological and pathological factors. Methods The study enrolled patients diagnosed with ADH at ultrasound-guided CNB who subsequently underwent surgical excision of the lesion. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy. Results A total of 102 patients with ADH at CNB were identified. Of the 74 patients who underwent subsequent surgical excision, 34 (45.8%) were diagnosed with invasive or in situ malignant foci. Multivariate analysis revealed that age [50 years, microcalcification on mammography, size on imaging [15 mm and a palpable lesion were independent predictors of malignancy. Focal ADH was a negative predictor. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.903 (95% CI: 0.82-0.94), and the negative predictive value was 100% for a score B3.5. Similar findings were observed for a validation dataset of 54 patients at other institutions. Conclusions A scoring system to predict malignancy in patients diagnosed with ADH at CNB was developed based on five factors: age, palpable lesion, microcalcification on mammography, size on imaging and focal ADH. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate.

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Papillary Lesions of the Breast: Evaluation with Stereotactic Directional Vacuum-assisted Biopsy

Cited by 124 publications

References 13 publications

Comparison of Sonographically Guided Core Needle Biopsy and Excision in Breast Papillomas

Comparison of Sonographically Guided Core Needle Biopsy and Excision in Breast Papillomas

Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy

Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy

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