title: Benign papillomas without atypia diagnosed on core needle biopsy: experience from a single institution and proposed criteria for excision.
abstract: BACKGROUND
  The management of benign papilloma (BP) without atypia identified on breast core needle biopsy (CNB) is controversial. In this study, we determined the upgrade rate to malignancy for BPs without atypia diagnosed on CNB and whether there are factors associated with upgrade.
  
  
  METHODS
  Through our pathology database search, we studied 80 BPs without atypia identified on CNB from 80 patients from 1997 to 2010, including 30 lesions that had undergone excision and 50 lesions that had undergone ≥ 2 years of radiologic follow-up. Associations between surgery or upgrade to malignancy and clinical, radiologic, and pathologic features were analyzed.
  
  
  RESULTS
  Mass lesions, lesions sampled by ultrasound-guided CNB, and palpable lesions were associated with surgical excision. All 3 upgraded cases were mass lesions sampled by ultrasound-guided CNB. None of the lesions with radiologic follow-up only were upgraded to malignancy. The overall upgrade rate was 3.8%. None of the clinical, radiologic, or histologic features were predictive of upgrade.
  
  
  CONCLUSIONS
  Because the majority of patients can be safely managed with radiologic surveillance, a selective approach for surgical excision is recommended. Our proposed criteria for excision include pathologic/radiologic discordance or sampling by ultrasound-guided CNB without vacuum assistance when the patient is symptomatic or lesion size is ≥ 1.5 cm.
authors.affiliation: Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Anupma
authors.initials: A
authors.lastname: Nayak
authors.forename: Selin
authors.initials: S
authors.lastname: Carkaci
authors.forename: Michael Z
authors.initials: MZ
authors.lastname: Gilcrease
authors.forename: Ping
authors.initials: P
authors.lastname: Liu
authors.forename: Lavinia P
authors.initials: LP
authors.lastname: Middleton
authors.forename: Roland L
authors.initials: RL
authors.lastname: Bassett
authors.forename: Jinxia
authors.initials: J
authors.lastname: Zhang
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
authors.forename: Robin L
authors.initials: RL
authors.lastname: Coyne
authors.forename: Therese B
authors.initials: TB
authors.lastname: Bevers
authors.forename: Nour
authors.initials: N
authors.lastname: Sneige
authors.forename: Lei
authors.initials: L
authors.lastname: Huo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008875:Middle Aged; D010212:Papilloma / Q000175:diagnosis* / Q000601:surgery; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016217:Ultrasonography, Mammary
keywords: Breast; Core needle biopsy; Criteria; Papilloma; Upgrade