title: Asymptomatic Benign Papilloma Without Atypia Diagnosed at Ultrasonography-Guided 14-Gauge Core Needle Biopsy: Which Subgroup can be Managed by Observation?
abstract: For asymptomatic benign papillomas detected at ultrasonography-guided 14-gauge core-needle biopsy (US-CNB), the decision to perform excision versus observation has been a topic of debate. We sought to determine which subgroup of asymptomatic benign papillomas without atypia diagnosed at US-CNB can be safely managed by observation versus immediate excision.
  
  
  
  Overall, 230 asymptomatic benign papillomas in 197 women (mean age 46.6 ± 9.5 years; range 22-78), diagnosed at US-CNB using immunohistochemistry staining when needed and then managed by surgery (n = 144) or vacuum-assisted excision (VAE) with at least 12 months of follow-up after benign VAE results (n = 86) were included in this study. The upgrade rate to malignancy was calculated. Clinical and radiological variables, including age, size, Breast Image Reporting and Data System (BI-RADS) category, and imaging-pathology correlation were evaluated to find associations with malignancy using multivariate analysis.
  
  
  
  The upgrade rate to malignancy was 2.6 % (6 of 230): four were ductal carcinomas in situ and two were 1.5- and 9-mm-sized invasive ductal carcinomas without lymph node metastasis. The upgrade rates of papillomas with a BI-RADS category 3-4a and imaging-pathology concordance were 1.4 and 1.8 %, respectively. Category 4b-5 and imaging-pathology discordance were independently associated with malignancy, with upgrade rates of 13 and 50 %, respectively. Age and lesion size were not associated with malignancy.
  
  
  
  Asymptomatic benign papillomas with probable benign or low suspicious US features or imaging-pathology concordance can be followed-up as opposed to immediate excision.
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Soo-Yeon
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eun-Kyung
authors.initials: EK
authors.lastname: Kim
authors.affiliation: Biostatistics Collaboration Unit, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Min Jung
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Yoon
authors.affiliation: Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ja Seung
authors.initials: JS
authors.lastname: Koo
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea. artemis4u@yuhs.ac.
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Moon
mesh_terms: D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D064887:Observational Studies as Topic; D010212:Papilloma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult