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Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up.
Am J Surg. 2009 Apr; 197(4):473-8.AJ

Abstract

BACKGROUND

Papillary breast lesions comprise a spectrum of histopathologic diagnoses ranging from benign papillomas to papillary carcinomas. There is ongoing controversy regarding the management of papillary lesions diagnosed by core needle biopsy (CNB). Some authors advocate observation of papillary lesions when the CNB is benign, while others recommend surgical excision of all papillary lesions. The current study assessed the adequacy of CNB in evaluating papillary breast lesions.

METHODS

A search of the pathology database at our institution identified 122 papillary lesions diagnosed by CNB. The study population consisted of 71 papillary lesions that were subsequently surgically excised.

RESULTS

Of the 71 papillary lesions excised, 8 were malignant, 16 were atypical, and 47 were benign at the time of CNB. Of the 47 papillary lesions thought to be benign, 13 (28%) revealed atypia and 4 (9%) revealed malignancy upon surgical excision. Of the 13 atypical papillary lesions on CNB, 7 lesions (54%) were associated with malignancy upon excision. Slightly over half the upgrades were due to finding atypia or malignancy in the tissue surrounding the papillary lesion. The total rate of upgrades from the CNB diagnosis to the excisional diagnosis was 38%.

CONCLUSIONS

When a core biopsy of a papillary lesion is encountered, there is a strong likelihood of discovering atypia or malignancy in the index lesion or in close proximity. Therefore, surgical excision should be performed to avoid missing a malignancy and to allow for accurate breast cancer risk assessment that can impact survival and decisions regarding chemoprevention.

Authors+Show Affiliations

St Vincent's Comprehensive Cancer Center, New York, NY 10011, USA. sbernik@aptiumoncology.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18723154

Citation

Bernik, Stephanie F., et al. "Papillary Lesions of the Breast Diagnosed By Core Needle Biopsy: 71 Cases With Surgical Follow-up." American Journal of Surgery, vol. 197, no. 4, 2009, pp. 473-8.
Bernik SF, Troob S, Ying BL, et al. Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up. Am J Surg. 2009;197(4):473-8.
Bernik, S. F., Troob, S., Ying, B. L., Simpson, S. A., Axelrod, D. M., Siegel, B., Moncrief, R. M., Mills, C., & Aziz, M. (2009). Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up. American Journal of Surgery, 197(4), 473-8. https://doi.org/10.1016/j.amjsurg.2008.04.007
Bernik SF, et al. Papillary Lesions of the Breast Diagnosed By Core Needle Biopsy: 71 Cases With Surgical Follow-up. Am J Surg. 2009;197(4):473-8. PubMed PMID: 18723154.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up. AU - Bernik,Stephanie F, AU - Troob,Scott, AU - Ying,Benjamin L, AU - Simpson,Scott A, AU - Axelrod,Deborah M, AU - Siegel,Beth, AU - Moncrief,Robyn M, AU - Mills,Christopher, AU - Aziz,Mohamed, Y1 - 2008/08/23/ PY - 2008/01/08/received PY - 2008/04/04/revised PY - 2008/04/09/accepted PY - 2008/8/30/pubmed PY - 2009/4/15/medline PY - 2008/8/30/entrez SP - 473 EP - 8 JF - American journal of surgery JO - Am J Surg VL - 197 IS - 4 N2 - BACKGROUND: Papillary breast lesions comprise a spectrum of histopathologic diagnoses ranging from benign papillomas to papillary carcinomas. There is ongoing controversy regarding the management of papillary lesions diagnosed by core needle biopsy (CNB). Some authors advocate observation of papillary lesions when the CNB is benign, while others recommend surgical excision of all papillary lesions. The current study assessed the adequacy of CNB in evaluating papillary breast lesions. METHODS: A search of the pathology database at our institution identified 122 papillary lesions diagnosed by CNB. The study population consisted of 71 papillary lesions that were subsequently surgically excised. RESULTS: Of the 71 papillary lesions excised, 8 were malignant, 16 were atypical, and 47 were benign at the time of CNB. Of the 47 papillary lesions thought to be benign, 13 (28%) revealed atypia and 4 (9%) revealed malignancy upon surgical excision. Of the 13 atypical papillary lesions on CNB, 7 lesions (54%) were associated with malignancy upon excision. Slightly over half the upgrades were due to finding atypia or malignancy in the tissue surrounding the papillary lesion. The total rate of upgrades from the CNB diagnosis to the excisional diagnosis was 38%. CONCLUSIONS: When a core biopsy of a papillary lesion is encountered, there is a strong likelihood of discovering atypia or malignancy in the index lesion or in close proximity. Therefore, surgical excision should be performed to avoid missing a malignancy and to allow for accurate breast cancer risk assessment that can impact survival and decisions regarding chemoprevention. SN - 1879-1883 UR - https://www.unboundmedicine.com/medline/citation/18723154/Papillary_lesions_of_the_breast_diagnosed_by_core_needle_biopsy:_71_cases_with_surgical_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9610(08)00382-6 DB - PRIME DP - Unbound Medicine ER -