Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy.
OBJECTIVE
To retrospectively determine the degree of underestimation of breast carcinoma diagnosis in papillary lesions initially diagnosed at core-needle biopsy.


METHODS
Institutional review board approval and waiver of informed consent were obtained for this HIPAA-compliant study. Mammographic database review (1994-2003) revealed core biopsy diagnoses of benign papilloma (n=38), atypical papilloma (n=15), sclerotic papilloma (n=6), and micropapilloma (n=4) in 57 women (mean age, 57 years). Excisional or mammographic follow-up (>or=2 years) findings were available. Patients with in situ or invasive cancer in the same breast or patients without follow-up were excluded. Findings were collected from mammography, ultrasonography, core technique, core biopsy, excision, and subsequent mammography. Reference standard was excisional findings or follow-up mammogram with no change at 2 years. Associations were examined with regression methods.


RESULTS
In 38 of 63 lesions, surgical excision was performed; in 25 additional lesions (considered benign), follow-up mammography (24-month minimum) was performed, with no interval change. In 15 lesions, 14-gauge core needle was used; in 48, vacuum assistance (mean cores per lesion, 8.7). Carcinoma was found at excision in 14 of 38 lesions. Core pathologic findings associated with malignancy were benign papilloma (n=1), sclerotic papilloma (n=1), micropapilloma (n=2), and atypical papilloma (n=10). Frequency of malignancy was one (3%) of 38 benign papillomas, 10 (67%) of 15 atypical papillomas, two (50%) of four micropapillomas, and one (17%) of six sclerotic papillomas. Excisional findings included lobular carcinoma in situ (n=2), ductal carcinoma in situ (n=7), papillary carcinoma (n=2), and invasive ductal carcinoma (n=3). Low-risk group (micropapillomas and sclerotic and benign papillomas) was compared with high-risk atypical papilloma group. Core findings were associated with malignancy at excision for atypical papilloma (P=.006). Lesion location, mammographic finding, core number, or needle type were not associated (P>.05) with underestimation of malignancy at excision.


CONCLUSIONS
Benign papilloma diagnosed at core biopsy is infrequently (3%) associated with malignancy; mammographic follow-up is reasonable. Because of the high association with malignancy (67%), diagnosis of atypical papilloma at core biopsy should prompt excision for definitive diagnosis.
Sydnor
Malcolm K
MK
Department of Radiology, Medical College of Virginia, Box 980615, Richmond, VA 23298-0615, USA. mksydnor@vcu.edu
Wilson
John D
JD
Hijaz
Tarek A
TA
Massey
H Davis
HD
Shaw de Paredes
Ellen S
ES
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000706:statistics & numerical data; D014768:Virginia / Q000453:epidemiology