title: Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy?
abstract: OBJECTIVE
  The study objective was to determine the cancer frequency in lesions yielding a benign, concordant diagnosis of papilloma at percutaneous breast biopsy.
  
  
  METHODS
  Retrospective review was performed of 3,864 lesions that had percutaneous imaging-guided biopsy. In 50 lesions (1.3%), percutaneous biopsy yielded a benign, concordant diagnosis of papilloma. Surgical pathology (n = 25) or minimum 2 years' mammographic follow-up (n = 10) was available for 35 lesions that had biopsy with 11-gauge vacuum-assisted (n = 20) or 14-gauge automated (n = 15) needles. Medical records, imaging studies, and histologic results were reviewed.
  
  
  RESULTS
  Cancer was found in five (14%) of the 35 lesions yielding a benign, concordant diagnosis of papilloma at percutaneous biopsy. Cancer histology was ductal carcinoma in situ in four (80%) and node-negative invasive cancer in one. Four (80%) of five cancers were identified due to interval change at follow-up (median, 22 months; range, 7-25 months). In six (17%) of 35 lesions, surgery revealed high-risk lesions including atypical ductal hyperplasia (n = 3), radial scar (n = 2), and lobular carcinoma in situ (n = 1). There was a significantly (p = 0.02) higher frequency of cancer or high-risk lesion in women with multiple versus solitary papillomas and a trend (p = 0.09) toward a higher cancer rate in women with versus without a family history of breast cancer. Breast cancer history, menopausal status, mammographic pattern, biopsy method, and removal of imaging target had no significant impact on cancer rate.
  
  
  CONCLUSIONS
  In our study of percutaneously diagnosed papillomas, surgery revealed cancer in 14% and high-risk lesions in 17%. Lesions yielding a benign, concordant diagnosis of papilloma at percutaneous biopsy may warrant surgical excision.
authors.affiliation: Breast Imaging Research Programs, Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA. libermal@mskcc.org
authors.forename: Laura
authors.initials: L
authors.lastname: Liberman
authors.forename: Carmen
authors.initials: C
authors.lastname: Tornos
authors.forename: Renata
authors.initials: R
authors.lastname: Huzjan
authors.forename: Lia
authors.initials: L
authors.lastname: Bartella
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Morris
authors.forename: D David
authors.initials: DD
authors.lastname: Dershaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010212:Papilloma / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies