Histological evaluation of papillary lesions of the breast from needle biopsy to the excised specimen: a single institutional experience.Pathologica. 2013 Apr; 105(2):51-5.P
The assessment and categorization of papillary lesions remains one of the most challenging areas in breast pathology. We evaluated the histological follow-up of papillary lesions of the breast from needle core biopsy to final excision to determine whether these lesions warrant excision, irrespective of histologic subtype.
A total of 91 needle core biopsies from the breast diagnosed as "papillary lesions" at our institution from January 2001 to June 2011 were included in the study. Twenty-nine of these (mean patient age 54.93 +/- 12.5 SD) were reported as benign papillary lesions, and the remaining 62 (mean patient age 61.98 +/- 15.20 SD) were diagnosed as either atypical papillary lesions (17 cases) or malignant papillary lesions (45 cases). RESULTS. Of the 29 needle core biopsies reported as benign, 19 cases (65.5%) were diagnosed as benign and three (10.3%) were diagnosed as malignant on follow-up. The remaining seven cases did not proceed to excision. Sixty-two of the 91 cases were given a diagnosis of either atypical papillary lesion or malignant papillary lesion on needle core biopsy. Of the 45 cases initially diagnosed as malignant, 44 (97.7%) were eventually deemed malignant and one atypical ductal hyperplasia (ADH) was found upon excision. The initial diagnosis of atypical papillary lesion was rendered in 17 cases, of which 10 turned out to be malignant, five ADH, and two benign on excision.
We conclude that if a benign papillary lesion is present on initial needle core biopsy, then the probability of malignancy is high (10.3%) on the final excision. Similarly, all malignant papillary lesions diagnosed on needle core biopsy should be excised due to the very high likelihood (97.7%) of a diagnosis of malignancy on final excision. Based on our results, we suggest surgical excision of any papillary lesion diagnosed on needle core biopsy.