title: Management of Clinically and Mammographically Occult Benign Papillary Lesions Diagnosed at Ultrasound-Guided 14-Gauge Breast Core Needle Biopsy.
abstract: OBJECTIVE
  To determine how to manage clinically and mammographically occult benign papillary lesions diagnosed at ultrasound (US)-guided 14-gauge breast core needle biopsy (CNB) by evaluating their upgrade rates.
  
  
  METHODS
  From our pathologic database of US-guided 14-gauge breast CNB, 69 benign papillomas and 9 atypical papillomas with available subsequent excisional findings (surgery or vacuum-assisted removal with additional US follow-up for ≥2 years) or US follow-up alone (≥2 years) were included in this study. We analyzed their upgrade rates by using excisional or US follow-up findings, with no change at 2 years as the reference standard. Patient age, lesion size, lesion distance from the nipple, multiplicity, imaging-histologic concordance, and histologic findings were compared between groups with and without upgrades by statistical analysis.
  
  
  RESULTS
  Surgical excision was performed in 53 (67.9%) of 78 benign papillary lesions and revealed 5 upgrades (11.4%) to atypical papillomas in 44 benign papillomas and 2 upgrades (22.2%) to ductal carcinomas in situ in 9 atypical papillomas. Among 12 benign papillomas (15.4%) with vacuum-assisted removal and US follow-up (≥2 years), 1 (8.3%) was upgraded to atypical papilloma. The remaining 13 benign papillomas (16.7%) were followed with US and were stable after a 2-year follow-up period. There were no significant differences in the variables between the groups.
  
  
  CONCLUSIONS
  Uniform surgical excision is not a reasonable management strategy for clinically and mammographically occult benign papillary lesions diagnosed at US-guided 14-gauge breast CNB. Clinically and mammographically occult benign papillary lesions may be subsequently managed by vacuum-assisted removal or imaging follow-up if atypia is not found.
authors.affiliation: Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea.
authors.forename: Sung Mo
authors.initials: SM
authors.lastname: Moon
authors.affiliation: Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea hhkkjung@hanmail.net.
authors.forename: Hae Kyoung
authors.initials: HK
authors.lastname: Jung
authors.affiliation: Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea.
authors.forename: Kyung Hee
authors.initials: KH
authors.lastname: Ko
authors.affiliation: Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea.
authors.forename: Youdong
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea.
authors.forename: Kyong Sik
authors.initials: KS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D001707:Biopsy, Needle; D001940:Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: breast; breast ultrasound; core needle biopsy; papillary lesion; surgical excision; ultrasound