title: Papilloma diagnosed at MRI-guided vacuum-assisted breast biopsy: is surgical excision still warranted?
abstract: OBJECTIVE
  The objective of our study was to determine the frequency of cancer at surgery in breast lesions yielding papilloma at MRI-guided 9-gauge vacuum-assisted biopsy (VAB) and to determine whether any features are associated with cancer upgrade.
  
  
  METHODS
  For this study, 1487 MRI-guided vacuum-assisted biopsies performed from January 2004 to March 2011 were reviewed. Lesions yielding papilloma were identified and classified as papilloma with or without atypia. Surgical findings were reviewed to determine the cancer rate. Statistical analysis was performed and 95% CIs were calculated.
  
  
  RESULTS
  Papilloma was identified in 75 of the 1487 MRI-guided vacuum-assisted biopsies (5%). These 75 papillomas occurred in 73 women with a median age of 49 years (age range, 27-70 years). Of the 75 papillomas, 25 (33%) had atypia and 50 (67%) did not on core needle biopsy. Subsequent surgery of 67 of the 75 papillomas (89%) yielded ductal carcinoma in situ (DCIS) in four (6%; 95% CI, 2-15%). Surgery yielded DCIS in two of 23 papillomas with atypia (9%; 95% CI, 1-28%) at MRI-guided VAB and in two of 44 papillomas without atypia (5%; 95% CI, 0.4-16%) at MRI-guided VAB; these cancer rates did not differ significantly (p=0.6). Postmenopausal status (p=0.04) and histologic size of less than 0.2 cm (p=0.04) had a significant association with the cancer upgrade rate.
  
  
  CONCLUSIONS
  Papilloma with or without atypia was found in 5% of patients who underwent MRI-guided VAB during the study period. Surgery revealed cancer in 6%. DCIS was found at surgery in 9% of lesions yielding papilloma with atypia versus 5% of lesions yielding papilloma without atypia. For lesions yielding papilloma with or without atypia at MRI-guided VAB, surgical excision is warranted.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. brennans@mskcc.org
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Brennan
authors.forename: Adriana
authors.initials: A
authors.lastname: Corben
authors.forename: Laura
authors.initials: L
authors.lastname: Liberman
authors.forename: D David
authors.initials: DD
authors.lastname: Dershaw
authors.forename: Edi
authors.initials: E
authors.lastname: Brogi
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Van Zee
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle / Q000379:methods; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional; D008875:Middle Aged; D010212:Papilloma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014618:Vacuum