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Diagnostic evaluation of papillary lesions of the breast on core biopsy.
Mod Pathol. 2010 Jul; 23(7):1021-8.MP

Abstract

The management of asymptomatic intraductal papillary lesions of the breast diagnosed on core biopsy poses a challenge for patients and clinicians, as the distinction between common benign lesions and atypical or malignant varieties may be difficult without formal excision. The aim of this study was to determine whether a combination of histopathologic and biomarker features could be used to accurately identify benign papillary lesions on core biopsy. An inclusive group of 127 excised papillary lesions was characterized by detailed histopathologic review and immunohistochemical staining for the basal markers cytokeratin 5/6 (CK5/6) and P63 and the proliferation marker Ki67. Comparison of benign, atypical, and malignant lesions revealed that the combination of broad, sclerotic fibrovascular cores, and epithelial CK5/6 staining was most commonly seen in benign papillomas. Ki67 staining revealed striking intralesional heterogeneity, but there was no difference between the high scores of benign, atypical, or malignant lesions (P=0.173). In a non-overlapping set of 42 cases, a binary classifier specifying benign lesions on the basis of thick fibrovascular cores and epithelial CK5/6 staining on core biopsy gave an overall misclassification rate of 4/42 (10%) when compared with the final excision diagnosis. Misclassified cases included 2/27 lesions ultimately diagnosed as benign and 2/2 atypical papillomas. All malignant lesions (n=13) were correctly assigned. The combined assessment of fibrovascular core thickness and CK5/6 staining on core biopsy distinguished benign from malignant papillary lesions, but did not separate benign from atypical cases. This approach may form a useful addition to the clinicopathologic evaluation of papillary lesions of the breast.

Authors+Show Affiliations

Department of Tissue Pathology, Institute of Clinical Pathology and Medical Research, Sydney West Area Health Service, Westmead, NSW, Australia. nirmala.pathmanathan@swahs.health.nsw.gov.auNo 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

20473278

Citation

Pathmanathan, Nirmala, et al. "Diagnostic Evaluation of Papillary Lesions of the Breast On Core Biopsy." Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, vol. 23, no. 7, 2010, pp. 1021-8.
Pathmanathan N, Albertini AF, Provan PJ, et al. Diagnostic evaluation of papillary lesions of the breast on core biopsy. Mod Pathol. 2010;23(7):1021-8.
Pathmanathan, N., Albertini, A. F., Provan, P. J., Milliken, J. S., Salisbury, E. L., Bilous, A. M., Byth, K., & Balleine, R. L. (2010). Diagnostic evaluation of papillary lesions of the breast on core biopsy. Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, 23(7), 1021-8. https://doi.org/10.1038/modpathol.2010.81
Pathmanathan N, et al. Diagnostic Evaluation of Papillary Lesions of the Breast On Core Biopsy. Mod Pathol. 2010;23(7):1021-8. PubMed PMID: 20473278.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic evaluation of papillary lesions of the breast on core biopsy. AU - Pathmanathan,Nirmala, AU - Albertini,Ann-Flore, AU - Provan,Pamela J, AU - Milliken,Jane S, AU - Salisbury,Elizabeth L, AU - Bilous,A Michael, AU - Byth,Karen, AU - Balleine,Rosemary L, Y1 - 2010/05/14/ PY - 2010/5/18/entrez PY - 2010/5/18/pubmed PY - 2010/10/7/medline SP - 1021 EP - 8 JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc JO - Mod Pathol VL - 23 IS - 7 N2 - The management of asymptomatic intraductal papillary lesions of the breast diagnosed on core biopsy poses a challenge for patients and clinicians, as the distinction between common benign lesions and atypical or malignant varieties may be difficult without formal excision. The aim of this study was to determine whether a combination of histopathologic and biomarker features could be used to accurately identify benign papillary lesions on core biopsy. An inclusive group of 127 excised papillary lesions was characterized by detailed histopathologic review and immunohistochemical staining for the basal markers cytokeratin 5/6 (CK5/6) and P63 and the proliferation marker Ki67. Comparison of benign, atypical, and malignant lesions revealed that the combination of broad, sclerotic fibrovascular cores, and epithelial CK5/6 staining was most commonly seen in benign papillomas. Ki67 staining revealed striking intralesional heterogeneity, but there was no difference between the high scores of benign, atypical, or malignant lesions (P=0.173). In a non-overlapping set of 42 cases, a binary classifier specifying benign lesions on the basis of thick fibrovascular cores and epithelial CK5/6 staining on core biopsy gave an overall misclassification rate of 4/42 (10%) when compared with the final excision diagnosis. Misclassified cases included 2/27 lesions ultimately diagnosed as benign and 2/2 atypical papillomas. All malignant lesions (n=13) were correctly assigned. The combined assessment of fibrovascular core thickness and CK5/6 staining on core biopsy distinguished benign from malignant papillary lesions, but did not separate benign from atypical cases. This approach may form a useful addition to the clinicopathologic evaluation of papillary lesions of the breast. SN - 1530-0285 UR - https://www.unboundmedicine.com/medline/citation/20473278/Diagnostic_evaluation_of_papillary_lesions_of_the_breast_on_core_biopsy_ L2 - https://doi.org/10.1038/modpathol.2010.81 DB - PRIME DP - Unbound Medicine ER -