title: Benign Papillomas of the Breast Diagnosed on Large-Gauge Vacuum Biopsy compared with 14 Gauge Core Needle Biopsy - Do they require surgical excision?
abstract: To evaluate whether biopsy with vacuum-assisted biopsy (VAB) devices improves histologic underestimation rates of benign papillomas when compared to smaller bore core needle biopsy (CNB) devices. Patients with biopsy-proven benign papillomas with surgical resection or minimum 12 months follow-up were selected. Two breast pathologists reviewed all pathology slides of percutaneous and excisional biopsy specimens. Histologic underestimation rates for lesions biopsied with 10-12 Gauge (G) VAB were compared to those with 14G CNB. A total of 107 benign papillomas in 107 patients from two centers were included. There were 60 patients (mean age 57 years, SD 10.3 years) diagnosed with VAB and 47 patients (mean age 57.6 years, SD 11.3 years) with 14G CNB who underwent surgical excision or imaging follow-up. The upgrade rate to ductal carcinoma in situ or invasive carcinoma was 1.6% (1/60) with VAB and 8.5% (4/47) with 14G. Upgrade to atypia was 3.3% (2/60) after VAB and 10.6% (5/47) with CNB. The total underestimation rates were 5% (3/60) with VAB and 19.1% (9/47) with CNB. The odds of an upgrade to malignancy was 5.5 times higher with a 14G needle than VAB (95% CI: 0.592-50.853, p = 0.17). We observed a lower but not statistically significant upgrade rate to malignancy and atypia with the use of the 10-12 G VAB as compared with 14G CNB. When a papilloma without atypia is diagnosed with vacuum biopsy there is a high likelihood that it is benign; however, if surgical excision is not performed, long-term follow-up is still required.
authors: Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
authors: Jean M
authors: JM
authors: Seely
authors: The Ottawa Hospital, Ottawa, Ontario, Canada.|University of Ottawa, Ottawa, Ontario, Canada.
authors: Raman
authors: R
authors: Verma
authors: The Ottawa Hospital, Ottawa, Ontario, Canada.|University of Ottawa, Ottawa, Ontario, Canada.|Royal Victoria Hospital, Barrie, Ontario, Canada.
authors: Ania
authors: A
authors: Kielar
authors: The Ottawa Hospital, Ottawa, Ontario, Canada.|University of Ottawa, Ottawa, Ontario, Canada.
authors: Karl R
authors: KR
authors: Smyth
authors: Sunnybrook Hospital, Toronto, Ontario, Canada.
authors: Kalesha
authors: K
authors: Hack
authors: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors: Monica
authors: M
authors: Taljaard
authors: Department of Pathology, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors: Denis
authors: D
authors: Gravel
authors: Royal Victoria Hospital, Barrie, Ontario, Canada.
authors: Erin
authors: E
authors: Ellison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010212:Papilloma / Q000473:pathology*; D000072177:Radiologists; D016217:Ultrasonography, Mammary / Q000379:methods; D014618:Vacuum
keywords: biopsy; breast diseases; breast mammography; breast neoplasms; breast ultrasonography; core biopsy; papillary lesions; papillomas; underestimation rate; vacuum-assisted biopsy