title: Management of ultrasonographically detected benign papillomas of the breast at core needle biopsy.
abstract: OBJECTIVE
  The purpose of this study is to retrospectively assess the upgrade rate determined by surgery for sonographically detected benign papillomas at core needle biopsy.
  
  
  METHODS
  Sixty-four benign papillomas, detected during screening ultrasound and diagnosed at ultrasound-guided core needle biopsy in 58 patients (mean age, 44.6 years; range, 30-67 years), were surgically excised. The upgrade rate to atypical lesion and malignancy was determined on a per-lesion basis. Statistical analysis was performed to evaluate whether patients' age and lesion variables (i.e., size, distance from the nipple, and ultrasound findings) affected the upgrade rate.
  
  
  RESULTS
  Surgical excision revealed the presence of benign papillomas in 43 cases, no residual lesion in 12 cases, atypical papillomas in seven cases, and papillary ductal carcinoma in situ in two cases. The upgrade rates to atypical papilloma and to malignancy were 10.9% (7/64; 95% CI, 4.51-21.3%) and 3.1% (2/64; 95% CI, 0.38-10.8%), respectively. Mean lesion size was significantly larger for lesions that were upgraded to malignancies (1.4 cm vs 0.9 cm) (p = 0.04). Age, distance from the nipple, and ultrasound findings were not significantly associated with underestimation of atypical lesions or malignancies after excision (p > 0.05).
  
  
  CONCLUSIONS
  Our results show that the upgrade rate to malignancy determined by surgery for ultrasound-detected benign papillomas at core needle biopsy was 3.1% (2/64). Accordingly, for the accurate diagnosis of ultrasound-detected benign papillomas at core needle biopsy, surgical excision is recommended.
authors.affiliation: Department of Radiology and Clinical Research Institute, Seoul National University Hospital, Seoul National University Medical Research Center, Yongon-dong, Chongno-gu, Republic of Korea.
authors.forename: Jung Min
authors.initials: JM
authors.lastname: Chang
authors.forename: Woo Kyung
authors.initials: WK
authors.lastname: Moon
authors.forename: Nariya
authors.initials: N
authors.lastname: Cho
authors.forename: Wonshik
authors.initials: W
authors.lastname: Han
authors.forename: Dong-Young
authors.initials: DY
authors.lastname: Noh
authors.forename: In-Ae
authors.initials: IA
authors.lastname: Park
authors.forename: Eun-Jung
authors.initials: EJ
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008875:Middle Aged; D010212:Papilloma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*; D016217:Ultrasonography, Mammary / Q000379:methods*