title: Diagnosing papillary lesions using vacuum-assisted breast biopsy: should conservative or surgical management follow?
abstract: BACKGROUND
  This study evaluates the underestimation rate of papilloma lesions diagnosed with vacuum-assisted breast biopsy (VABB), taking into consideration the greater volume excised.
  
  
  METHODS
  56 women with a diagnosis of a papilloma lesion after VABB (Mammotest; Fischer Imaging, Denver, CO, USA) were evaluated. At least 24 cores were excised in all cases (mean 74, range 24-96 cores) and a preoperative diagnosis was established. Subsequently, open surgery using hook-wire localization followed. A second, postoperative diagnosis was independently and blindly made. The association between the pathological types and Breast Imaging Report and Data System (BI-RADS) classification, as well as the discrepancy between preoperative and postoperative diagnoses, was evaluated.
  
  
  RESULTS
  The underestimation rate of papillary lesions was 3.6%. When the papillary lesions did not coexist preoperatively with any other precursor breast lesions, the underestimation rate was 0%. The underestimation rate did not differ with age, BI-RADS category or type of lesion.
  
  
  CONCLUSIONS
  Conservative management of patients with a papillary lesion diagnosis may follow when the extended VABB protocol is adopted and a great tissue volume is excised. However, when diagnosing a coexisting papillary lesion with a precursor breast lesion, open surgery should follow, given the high probability of a postoperative cancer diagnosis.
authors.affiliation: Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, Athens, Greece. gzografo@med.uoa.gr
authors.forename: George C
authors.initials: GC
authors.lastname: Zografos
authors.forename: Flora
authors.initials: F
authors.lastname: Zagouri
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Sergentanis
authors.forename: Aphrodite
authors.initials: A
authors.lastname: Nonni
authors.forename: Nikolaos V
authors.initials: NV
authors.lastname: Michalopoulos
authors.forename: Panagiota
authors.initials: P
authors.lastname: Kontogianni
authors.forename: Dimitra
authors.initials: D
authors.lastname: Koulocheri
authors.forename: Irene E
authors.initials: IE
authors.lastname: Dimitriadis
authors.forename: John
authors.initials: J
authors.lastname: Bramis
authors.forename: Effstratios
authors.initials: E
authors.lastname: Patsouris
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000628:therapy*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008408:Mastectomy; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity