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Benign breast papillomas without atypia diagnosed with core needle biopsy: Outcome of surgical excision and imaging follow-up.
Eur J Radiol. 2020 Oct; 131:109237.EJ

Abstract

PURPOSE

To evaluate the surgical upgrade rate to malignancy and high-risk lesions in cases of papilloma without atypia diagnosed with imaging-guided percutaneous core needle biopsy (CNB) and to determine whether any lesion imaging features, biopsy techniques, and pathological factors can predict lesion upgrade to help guide clinical management.

MATERIALS AND METHODS

Benign papillomas without atypia (n = 399) diagnosed with CNB were retrospectively reviewed. The surgical upgrade rate to malignancy or high-risk lesion (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in-situ, flat epithelial atypia and atypical papilloma) was determined. Detection modality (i.e. mammography, ultrasonography (US), magnetic resonance imaging (MRI)), lesion type and size, biopsy-guidance modality (US, stereotactic, MRI), biopsy needle size (<14 G vs ≥14 G), use of vacuum assistance, and presenting symptoms were statistically analyzed. The reference standard for evaluation of upgrade was either excision or at least 24 months of imaging follow-up. Chi Square test and Fisher exact tests were performed for categorical variables, and the Mann-Whitney-U test was used for continuous variables.

RESULTS

Ultrasound was the predominant biopsy modality (78.4 %, p < 0.001). Of the 399 benign papilloma lesions in 329 women, 239 (59.9 %) were excised and 93 others were followed for at least 24 months (total of 332). Of these 332 lesions, 7 (2.1 %) were upgraded to ductal carcinoma in-situ and 41 (12.3 %) to high-risk lesions at excision. Larger lesion size (≥15 mm, p = 0.009), smaller biopsy needle size (≥14 G, p = 0.027), and use of spring-loaded biopsy device (p = 0.012) were significantly associated with upgrade to atypia. Only lesion size (≥15 mm, p = 0.02) was associated with upgrade to cancer.

CONCLUSION

Upgrade to malignancy of biopsy-proven benign papillomas without atypia at the time of surgery was sufficiently low (2.1 %) to support non-operative management. Surgery may be performed for selected cases- those with larger lesion size and those whose biopsies were performed with smaller spring-loaded biopsy needles.

Authors+Show Affiliations

Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: Dogan.polat@utsouthwestern.edu.Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: Emily.Knippa@UTSouthwestern.edu.Department of Radiology and Medical Imaging, University of Virginia, United States. Electronic address: rg8xp@hscmail.mcc.virginia.edu.Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: Stephen.Seiler@UTSouthwestern.edu.Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: Sally.Goudreau@UTSouthwestern.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32905954

Citation

Polat, Dogan S., et al. "Benign Breast Papillomas Without Atypia Diagnosed With Core Needle Biopsy: Outcome of Surgical Excision and Imaging Follow-up." European Journal of Radiology, vol. 131, 2020, p. 109237.
Polat DS, Knippa EE, Ganti R, et al. Benign breast papillomas without atypia diagnosed with core needle biopsy: Outcome of surgical excision and imaging follow-up. Eur J Radiol. 2020;131:109237.
Polat, D. S., Knippa, E. E., Ganti, R., Seiler, S. J., & Goudreau, S. H. (2020). Benign breast papillomas without atypia diagnosed with core needle biopsy: Outcome of surgical excision and imaging follow-up. European Journal of Radiology, 131, 109237. https://doi.org/10.1016/j.ejrad.2020.109237
Polat DS, et al. Benign Breast Papillomas Without Atypia Diagnosed With Core Needle Biopsy: Outcome of Surgical Excision and Imaging Follow-up. Eur J Radiol. 2020;131:109237. PubMed PMID: 32905954.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Benign breast papillomas without atypia diagnosed with core needle biopsy: Outcome of surgical excision and imaging follow-up. AU - Polat,Dogan S, AU - Knippa,Emily E, AU - Ganti,Ramapriya, AU - Seiler,Stephen J, AU - Goudreau,Sally H, Y1 - 2020/08/28/ PY - 2020/06/10/received PY - 2020/08/05/revised PY - 2020/08/16/accepted PY - 2020/9/10/pubmed PY - 2021/3/25/medline PY - 2020/9/9/entrez KW - Benign papilloma KW - Breast biopsy KW - Breast cancer KW - Breast imaging KW - High-risk lesions SP - 109237 EP - 109237 JF - European journal of radiology JO - Eur J Radiol VL - 131 N2 - PURPOSE: To evaluate the surgical upgrade rate to malignancy and high-risk lesions in cases of papilloma without atypia diagnosed with imaging-guided percutaneous core needle biopsy (CNB) and to determine whether any lesion imaging features, biopsy techniques, and pathological factors can predict lesion upgrade to help guide clinical management. MATERIALS AND METHODS: Benign papillomas without atypia (n = 399) diagnosed with CNB were retrospectively reviewed. The surgical upgrade rate to malignancy or high-risk lesion (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in-situ, flat epithelial atypia and atypical papilloma) was determined. Detection modality (i.e. mammography, ultrasonography (US), magnetic resonance imaging (MRI)), lesion type and size, biopsy-guidance modality (US, stereotactic, MRI), biopsy needle size (<14 G vs ≥14 G), use of vacuum assistance, and presenting symptoms were statistically analyzed. The reference standard for evaluation of upgrade was either excision or at least 24 months of imaging follow-up. Chi Square test and Fisher exact tests were performed for categorical variables, and the Mann-Whitney-U test was used for continuous variables. RESULTS: Ultrasound was the predominant biopsy modality (78.4 %, p < 0.001). Of the 399 benign papilloma lesions in 329 women, 239 (59.9 %) were excised and 93 others were followed for at least 24 months (total of 332). Of these 332 lesions, 7 (2.1 %) were upgraded to ductal carcinoma in-situ and 41 (12.3 %) to high-risk lesions at excision. Larger lesion size (≥15 mm, p = 0.009), smaller biopsy needle size (≥14 G, p = 0.027), and use of spring-loaded biopsy device (p = 0.012) were significantly associated with upgrade to atypia. Only lesion size (≥15 mm, p = 0.02) was associated with upgrade to cancer. CONCLUSION: Upgrade to malignancy of biopsy-proven benign papillomas without atypia at the time of surgery was sufficiently low (2.1 %) to support non-operative management. Surgery may be performed for selected cases- those with larger lesion size and those whose biopsies were performed with smaller spring-loaded biopsy needles. SN - 1872-7727 UR - https://www.unboundmedicine.com/medline/citation/32905954/Benign_breast_papillomas_without_atypia_diagnosed_with_core_needle_biopsy:_Outcome_of_surgical_excision_and_imaging_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0720-048X(20)30426-5 DB - PRIME DP - Unbound Medicine ER -