title: Underestimation of papillary breast lesions by core biopsy: correlation to surgical excision.
abstract: BACKGROUND
  The purpose of this study was to evaluate papillary lesions of the breast diagnosed at needle core biopsy and the outcomes of follow-up imaging and surgical findings.
  
  
  METHODS
  Retrospective review of 13,806 needle core biopsies performed from 2004 to 2010 revealed 352 patients with 368 papillary lesions; 137 of these lesions underwent surgical excision and 215 had a minimum of 2 year imaging follow-up. Outcomes of imaging follow-up and underestimation of carcinoma by comparison to surgical excision, as applicable, were determined. Patient demographics, clinical presentation, BI-RADS(®) breast density, palpability, biopsy methods, number of specimens, and pathology were recorded. A two-tailed Fisher exact test was used to assess associations between biopsy techniques and the results of surgical excision as well as the association between palpability and the results of surgical excision. SAS(®) V 9.1.3 was used to perform the calculations.
  
  
  RESULTS
  One hundred and thirty-seven lesions proceeded to surgical excision. A total of 28 lesions were underestimated; 21 of these were underestimated carcinomas. When comparing biopsy devices in the underestimated group, 64 % were biopsied with directional vacuum-assisted devices and 36 % with automated large core devices (p < 0.0706). In total 18 % of the palpable lesions were underestimated, whereas 17 % of the nonpalpable lesions were underestimated (p < 0.6560); this was not a significant difference.
  
  
  CONCLUSIONS
  Overall, carcinoma was underestimated at needle biopsy in 6 % (21/368) of papillary lesions diagnosed when compared to surgical excision. In cases that underwent excision, 34 % (47/137) revealed carcinoma; 45 % (21/47) of these were underestimated carcinomas. Lesion palpability and biopsy method did not affect underestimation in this study population.
authors.affiliation: Elizabeth Wende Breast Care, LLC., 170 Sawgrass Dr., Rochester, NY, 14620, USA, sdestounis@ewbc.com.
authors.forename: Stamatia
authors.initials: S
authors.lastname: Destounis
authors.forename: Posy
authors.initials: P
authors.lastname: Seifert
authors.forename: Patricia
authors.initials: P
authors.lastname: Somerville
authors.forename: Philip
authors.initials: P
authors.lastname: Murphy
authors.forename: Renee
authors.initials: R
authors.lastname: Morgan
authors.forename: Andrea
authors.initials: A
authors.lastname: Arieno
authors.forename: Wende Logan
authors.initials: WL
authors.lastname: Young
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D042361:Mammary Glands, Human / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult