title: The diagnosis of non-malignant papillary lesions of the breast: comparison of ultrasound-guided automated gun biopsy and vacuum-assisted removal.
abstract: OBJECTIVE
  To compare the histological upgrade rate of ultrasound (US)-guided vacuum-assisted removal (VAR) and US-14 G-automated core needle biopsy (ACNB) in the diagnosis of papillary breast lesions.
  
  
  METHODS
  Two hundred and seventy-one biopsies of 230 papillary lesions were examined, which underwent subsequent surgical excision or long-term follow-up after US-ACNB (n = 206) or US-VAR (n = 65). The false-negative and atypical papilloma underestimation rate were compared between the ACNB and VAR groups. Patient and lesion characteristics were collected. The histological upgrade rates of the diagnosis were estimated and compared.
  
  
  RESULTS
  Out of 271 papillary lesions, 195 (80.0%) were benign, 21 (7.7%) were atypical, and 55 (20.3%) were malignant. There were no false negatives or underestimated atypical papillomas in the VAR group. However, in the ACNB group, the false-negative rate was 7.6% (12 of 157 benign papillomas, 95% CI; 4.4-12.9%, p = 0.039) and the atypical papilloma underestimation rate was 33% (five of 15 atypical papillomas, 95% CI; 15.2-58.3%, p = 0.135). The histological upgrade rates of the diagnosis for papillary breast lesions were 0% for the VAR (0 of 66) group and 10.2% for the ACNB (21 of 206) group before adjusting for the population (p = 0.003).
  
  
  CONCLUSIONS
  ACNB was associated with significantly higher false-negative and histological upgrade rates of diagnosis for papillary breast lesions than VAR.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University Heath System, Seoul, South Korea.
authors.forename: M J
authors.initials: MJ
authors.lastname: Kim
authors.forename: S-I
authors.initials: SI
authors.lastname: Kim
authors.forename: J H
authors.initials: JH
authors.lastname: Youk
authors.forename: H J
authors.initials: HJ
authors.lastname: Moon
authors.forename: J Y
authors.initials: JY
authors.lastname: Kwak
authors.forename: B-W
authors.initials: BW
authors.lastname: Park
authors.forename: E-K
authors.initials: EK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010212:Papilloma / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*; D014618:Vacuum; D055815:Young Adult