Significance of papillary lesions at percutaneous breast biopsy.
BACKGROUND
The management of nonpalpable papillary lesions found in specimens obtained by percutaneous breast biopsy is controversial. We reviewed the treatment of patients found to have papillary lesions by stereotactic, sonographic, or fine-needle aspiration breast biopsy to identify indications for surgical excision.


METHODS
Consecutive patients with intraductal papilloma, atypical papilloma/papilloma with atypical ductal hyperplasia, papillary neoplasm, and papillomatosis according to percutaneous breast biopsy were identified from radiology records. The charts were reviewed to identify patients who had subsequent surgical excision, and the pathologic findings were correlated with the biopsy method and indications for surgery.


RESULTS
Papillary lesions were found in 120 biopsy samples from 109 patients. Malignancy was found at operation in 19 (24%) of 80 lesions that underwent surgical excision: 12 (63%) were ductal carcinoma-in-situ, 4 (21%) were infiltrating ductal carcinoma, 2 (11%) were infiltrating papillary carcinoma, and 1 (5%) was intracystic papillary carcinoma. Malignancy was found in 9 (30%) of 30 fine-needle biopsy papillary lesions, 6 (35%) of 17 core biopsy papillary lesions, and 4 (12%) of 33 stereotactic biopsy papillary lesions. Malignancy was missed significantly less frequently with stereotactic biopsy (P<.05).


CONCLUSIONS
Malignancy is frequently found at surgical excision for papillary lesions found on percutaneous breast biopsy. Malignancy is missed significantly less frequently with stereotactic biopsy.
Department of Surgery, Comprehensive Breast Service, St. Luke's Roosevelt Medical Center, 425 West 59th Street Suite 7A, New York, New York 10019, USA. edvaldes@chpnet.org
Edna K
EK
Valdes
Paul I
PI
Tartter
Elvita
E
Genelus-Dominique
Deborah-Alexis
DA
Guilbaud
Sharon
S
Rosenbaum-Smith
Alison
A
Estabrook
D001707:Biopsy, Needle / Q000379:methods; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D010212:Papilloma / Q000473:pathology*; D018300:Papilloma, Intraductal / Q000473:pathology / Q000601:surgery; D016217:Ultrasonography, Mammary