title: Papillary lesions on core breast biopsy: excisional biopsy for all patients?
abstract: Excisional biopsy has been recommended for papillary lesions diagnosed on core needle biopsy (CNB) because a significant proportion of cases are upstaged to in situ/invasive cancer after surgical excision. The study goals were to identify patients at lowest risk of upstaging in whom excisional biopsy may potentially be avoided. We retrospectively evaluated 46 patients with a papillary lesion on CNB. Six patients were upstaged overall (13%), to intraductal papillary carcinoma (7%), invasive papillary carcinoma (4%), and mixed invasive ductal/lobular carcinoma (2%). The upstaging rate for patients with atypia on CNB was higher than for patients without atypia (33 vs 3%, P = 0.011). No patient younger than 65 years was upstaged to in situ or invasive carcinoma, and the mean lesion size was also higher among patients who were upstaged (P > 0.05). Patients younger than 65 years with small papillary lesions lacking atypia on CNB may therefore represent a low-risk group that may be offered close clinical and radiologic follow-up.
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Mayo Clinic, Phoenix, Arizona, USA.
authors.forename: Lee J
authors.initials: LJ
authors.lastname: McGhan
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Marina E
authors.initials: ME
authors.lastname: Giurescu
authors.forename: Ann E
authors.initials: AE
authors.lastname: McCullough
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010212:Papilloma / Q000473:pathology* / Q000601:surgery; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment