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Papilloma diagnosed at MRI-guided vacuum-assisted breast biopsy: is surgical excision still warranted?
AJR Am J Roentgenol. 2012 Oct; 199(4):W512-9.AA

Abstract

OBJECTIVE

The objective of our study was to determine the frequency of cancer at surgery in breast lesions yielding papilloma at MRI-guided 9-gauge vacuum-assisted biopsy (VAB) and to determine whether any features are associated with cancer upgrade.

MATERIALS AND METHODS

For this study, 1487 MRI-guided vacuum-assisted biopsies performed from January 2004 to March 2011 were reviewed. Lesions yielding papilloma were identified and classified as papilloma with or without atypia. Surgical findings were reviewed to determine the cancer rate. Statistical analysis was performed and 95% CIs were calculated.

RESULTS

Papilloma was identified in 75 of the 1487 MRI-guided vacuum-assisted biopsies (5%). These 75 papillomas occurred in 73 women with a median age of 49 years (age range, 27-70 years). Of the 75 papillomas, 25 (33%) had atypia and 50 (67%) did not on core needle biopsy. Subsequent surgery of 67 of the 75 papillomas (89%) yielded ductal carcinoma in situ (DCIS) in four (6%; 95% CI, 2-15%). Surgery yielded DCIS in two of 23 papillomas with atypia (9%; 95% CI, 1-28%) at MRI-guided VAB and in two of 44 papillomas without atypia (5%; 95% CI, 0.4-16%) at MRI-guided VAB; these cancer rates did not differ significantly (p=0.6). Postmenopausal status (p=0.04) and histologic size of less than 0.2 cm (p=0.04) had a significant association with the cancer upgrade rate.

CONCLUSION

Papilloma with or without atypia was found in 5% of patients who underwent MRI-guided VAB during the study period. Surgery revealed cancer in 6%. DCIS was found at surgery in 9% of lesions yielding papilloma with atypia versus 5% of lesions yielding papilloma without atypia. For lesions yielding papilloma with or without atypia at MRI-guided VAB, surgical excision is warranted.

Authors+Show Affiliations

Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. brennans@mskcc.orgNo 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

22997402

Citation

Brennan, Sandra B., et al. "Papilloma Diagnosed at MRI-guided Vacuum-assisted Breast Biopsy: Is Surgical Excision Still Warranted?" AJR. American Journal of Roentgenology, vol. 199, no. 4, 2012, pp. W512-9.
Brennan SB, Corben A, Liberman L, et al. Papilloma diagnosed at MRI-guided vacuum-assisted breast biopsy: is surgical excision still warranted? AJR Am J Roentgenol. 2012;199(4):W512-9.
Brennan, S. B., Corben, A., Liberman, L., Dershaw, D. D., Brogi, E., Van Zee, K. J., & Morris, E. (2012). Papilloma diagnosed at MRI-guided vacuum-assisted breast biopsy: is surgical excision still warranted? AJR. American Journal of Roentgenology, 199(4), W512-9.
Brennan SB, et al. Papilloma Diagnosed at MRI-guided Vacuum-assisted Breast Biopsy: Is Surgical Excision Still Warranted. AJR Am J Roentgenol. 2012;199(4):W512-9. PubMed PMID: 22997402.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Papilloma diagnosed at MRI-guided vacuum-assisted breast biopsy: is surgical excision still warranted? AU - Brennan,Sandra B, AU - Corben,Adriana, AU - Liberman,Laura, AU - Dershaw,D David, AU - Brogi,Edi, AU - Van Zee,Kimberly J, AU - Morris,Elizabeth, PY - 2012/9/22/entrez PY - 2012/9/22/pubmed PY - 2012/12/10/medline SP - W512 EP - 9 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 199 IS - 4 N2 - OBJECTIVE: The objective of our study was to determine the frequency of cancer at surgery in breast lesions yielding papilloma at MRI-guided 9-gauge vacuum-assisted biopsy (VAB) and to determine whether any features are associated with cancer upgrade. MATERIALS AND METHODS: For this study, 1487 MRI-guided vacuum-assisted biopsies performed from January 2004 to March 2011 were reviewed. Lesions yielding papilloma were identified and classified as papilloma with or without atypia. Surgical findings were reviewed to determine the cancer rate. Statistical analysis was performed and 95% CIs were calculated. RESULTS: Papilloma was identified in 75 of the 1487 MRI-guided vacuum-assisted biopsies (5%). These 75 papillomas occurred in 73 women with a median age of 49 years (age range, 27-70 years). Of the 75 papillomas, 25 (33%) had atypia and 50 (67%) did not on core needle biopsy. Subsequent surgery of 67 of the 75 papillomas (89%) yielded ductal carcinoma in situ (DCIS) in four (6%; 95% CI, 2-15%). Surgery yielded DCIS in two of 23 papillomas with atypia (9%; 95% CI, 1-28%) at MRI-guided VAB and in two of 44 papillomas without atypia (5%; 95% CI, 0.4-16%) at MRI-guided VAB; these cancer rates did not differ significantly (p=0.6). Postmenopausal status (p=0.04) and histologic size of less than 0.2 cm (p=0.04) had a significant association with the cancer upgrade rate. CONCLUSION: Papilloma with or without atypia was found in 5% of patients who underwent MRI-guided VAB during the study period. Surgery revealed cancer in 6%. DCIS was found at surgery in 9% of lesions yielding papilloma with atypia versus 5% of lesions yielding papilloma without atypia. For lesions yielding papilloma with or without atypia at MRI-guided VAB, surgical excision is warranted. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/22997402/Papilloma_diagnosed_at_MRI_guided_vacuum_assisted_breast_biopsy:_is_surgical_excision_still_warranted L2 - https://www.ajronline.org/doi/10.2214/AJR.12.8750 DB - PRIME DP - Unbound Medicine ER -