Diagnosing papillary lesions using vacuum-assisted breast biopsy: should conservative or surgical management follow?
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.
Zografos
George C
GC
Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, Athens, Greece. gzografo@med.uoa.gr
Zagouri
Flora
F
Sergentanis
Theodoros N
TN
Nonni
Aphrodite
A
Michalopoulos
Nikolaos V
NV
Kontogianni
Panagiota
P
Koulocheri
Dimitra
D
Dimitriadis
Irene E
IE
Bramis
John
J
Patsouris
Effstratios
E
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