Skip to main content

Advertisement

SpringerLink
Log in

Papillary Lesions Initially Diagnosed at Ultrasound-guided Vacuum-assisted Breast Biopsy: Rate of Malignancy Based on Subsequent Surgical Excision

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To prospectively determine the rate of malignancy after surgery in papillary lesions initially diagnosed at ultrasound (US)-guided 11-gauge vacuum-assisted breast biopsies.

Methods

Between May 2007 and December 2009, a total of 85 papillary lesions, including 73 benign papillomas and 12 atypical papillomas were diagnosed in 83 patients by US-guided 11-gauge vacuum-assisted breast biopsy. Surgical excision was recommended for all patients and 60 nonmalignant papillary lesions (49 benign papillomas and 11 atypical papillomas) in 60 patients (age range, 24–66 years; mean age, 45.0 years) were surgically excised. On a per-lesion basis, the upgrade rate to malignancy was calculated. Associations between clinical, lesion, and biopsy variables and the results of surgical excision were examined with a χ2 test.

Results

Surgical excision revealed the presence of benign papillomas in 34 cases, no residual lesion in 15 cases, atypical papillomas in nine cases, and ductal carcinoma-in-situ in two cases. The upgrade rate was 0% (0 of 49; 95% confidence interval 0–7.2) for benign papillomas and 18.2% (2 of 11; 95% confidence interval 2.3–51.8) for atypical papillomas. The core findings of atypical papillomas (P = 0.031) and age (P = 0.046) were associated with malignancy at excision, whereas personal or family history, presence of symptoms, multiplicity, lesion type, size, distance from the nipple, Breast Imaging Reporting and Data System (BI-RADS) category, and lesion removal at US showed no correlation to upgrade.

Conclusions

Surgical excision may not be required for lesions with a diagnosis of benign papilloma after US-guided 11-gauge vacuum-assisted breast biopsy, and a diagnosis of atypical papilloma should prompt excision for a definitive diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Parker SH, Burbank F, Jackman RJ, et al. Percutaneous large-core breast biopsy: a multi-institutional study. Radiology. 1994;193:359–64.

    PubMed  CAS  Google Scholar 

  2. Schueller G, Jaromi S, Ponhold L, et al. US-guided 14-gauge core needle breast biopsy: results of a validation study in 1352 cases. Radiology. 2008;248:406–13.

    Article  PubMed  Google Scholar 

  3. Ueng SH, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast. Arch Pathol Lab Med. 2009;133:893–907.

    PubMed  Google Scholar 

  4. Philpotts LE. Percutaneous breast biopsy: emerging techniques and continuing controversies. Semin Roentgenol. 2007;42:218–27.

    Article  PubMed  Google Scholar 

  5. Jaffer S, Nagi C, Bleiweiss IJ. Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy. Cancer. 2009;115:2837–43.

    Article  PubMed  Google Scholar 

  6. Cheng TY, Chen CM, Lee MY, et al. Risk factors associated with conversion from nonmalignant to malignant diagnosis after surgical excision of breast papillary lesions. Ann Surg Oncol. 2009;16:3375–9.

    Article  PubMed  Google Scholar 

  7. Mercado CL, Hamele-Bena D, Oken SM, Singer CI, Cangiarella J. Papillary lesions of the breast at percutaneous core needle biopsy. Radiology. 2006;238:801–8.

    Article  PubMed  Google Scholar 

  8. Rizzo M, Lund MJ, Oprea G, Schniederjan M, Wood WC, Mosunjac M. Surgical follow-up and clinical presentation of 142 breast papillary lesions diagnosed by ultrasound-guided core needle biopsy. Ann Surg Oncol. 2008;15:1040–7.

    Article  PubMed  Google Scholar 

  9. Chang JM, Moon WK, Cho N, et al. Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study. Eur Radiol. 2010;20:1093–100.

    Article  PubMed  Google Scholar 

  10. Sydnor MK, Wilson JD, Hijaz TA, Massey HD, Shaw de Paredes ES. Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core needle biopsy. Radiology. 2007;242:58–62.

    Article  PubMed  Google Scholar 

  11. Ahmadiyeh N, Stoleru MA, Raza S, Lester SC, Golshan M. Management of intraductal papillomas of the breast: an analysis of 129 cases and their outcome. Ann Surg Oncol. 2009;16:2264–9.

    Article  PubMed  Google Scholar 

  12. Bennett LE, Ghate SV, Bentley R, Baker JA. Is surgical excision of core biopsy proven benign papillomas of the breast necessary? Acad Radiol. 2010;5:553–7.

    Article  Google Scholar 

  13. Darling ML, Smith DN, Lester SC, et al. Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. AJR Am J Roentgenol. 2000;175:1341–6.

    PubMed  CAS  Google Scholar 

  14. Grady I, Gorsuch H, Wilburn-Bailey S. Ultrasound-guided, vacuum-assisted, percutaneous excision of breast lesions: an accurate technique in the diagnosis of atypical ductal hyperplasia. J Am Coll Surg. 2005;201:14–7.

    Article  PubMed  Google Scholar 

  15. Parker SH, Klaus AJ, McWey PJ, et al. Sonographically guided directional vacuum-assisted breast biopsy using a handheld device. AJR Am J Roentgenol. 2001;177:405–8.

    PubMed  CAS  Google Scholar 

  16. Cassano E, Urban LA, Pizzamiglio M, et al. Ultrasound-guided vacuum-assisted core breast biopsy: experience with 406 cases. Breast Cancer Res Treat. 2007;102:103–10.

    Article  PubMed  Google Scholar 

  17. Berg WA, Krebs TL, Campassi C, Magder LS, Sun CC. Evaluation of 14- and 11-gauge directional, vacuum-assisted biopsy probes and 14-gauge biopsy guns in a breast parenchymal model. Radiology. 1997;205:203–8.

    PubMed  CAS  Google Scholar 

  18. Kim MJ, Kim EK, Kwak JY, et al. Nonmalignant papillary lesions of the breast at US-guided directional vacuum-assisted removal: a preliminary report. Eur Radiol. 2008;189:1774–83.

    Article  Google Scholar 

  19. Maxwell AJ. Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience. Clin Radiol. 2009;64:801–6.

    Article  PubMed  CAS  Google Scholar 

  20. Zografos GC, Zagouri F, Sergentanis TN, et al. Diagnosing papillary lesions using vacuum-assisted breast biopsy: should conservative or surgical management follow? Onkologie. 2008;31:653–6.

    PubMed  Google Scholar 

  21. Mendelson EB, Baum JK, Berg WA, Merritt CRB, Rubin E. Breast imaging reporting and data system, BI-RADS: ultrasound. Reston, VA: American College of Radiology; 2003.

    Google Scholar 

  22. D’Orsi CJ, Bassett LW, Berg WA, et al. Breast imaging reporting and data system, BI-RADS: mammography. 4th ed. Reston, VA: American College of Radiology; 2003.

    Google Scholar 

  23. Berg WA. ACRIN protocol 6666. Available at: http://www.acrin.org/TabID/153/Default.aspx. Accessed August 14, 2010.

  24. Patterson SK, Joe A, Helvie MA. Sonographically-guided metallic marker placement at time of wire localization for intraductal or cystic lesions: a method to verify lesion retrieval. Acad Radiol. 2008;15:1316–21.

    Article  PubMed  Google Scholar 

  25. Phillips SW, Gabriel H, Comstock CE, Venta LA. Sonographically guided metallic clip placement after core needle biopsy of the breast. AJR Am J Roentgenol. 2000;175:1353–5.

    PubMed  CAS  Google Scholar 

  26. Berg WA. Image-guided breast biopsy and management of high-risk lesions. Radiol Clin North Am. 2004;42:935–46.

    Article  PubMed  Google Scholar 

  27. Shin HJ, Kim HH, Kim SM, et al. Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy: comparison of sonographic features and biopsy methods. AJR Am J Roentgenol. 2008;190:630–6.

    Article  PubMed  Google Scholar 

  28. Youk JH, Kim EK, Kwak JY, Son EJ. Atypical papilloma diagnosed by sonographically guided 14-gauge core needle biopsy of breast mass. AJR Am J Roentgenol. 2010;194:1397–402.

    Article  PubMed  Google Scholar 

  29. Page DL, Salhany KE, Jensen RA, Dupont WD. Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer. 1996;78:258–66.

    Article  PubMed  CAS  Google Scholar 

  30. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst. 2005;97:1652–62.

    Article  PubMed  CAS  Google Scholar 

  31. Jung SY, Kang HS, Kwon Y, et al. Risk factors for malignancy in benign papillomas of the breast on core needle biopsy. World J Surg. 2010; 34:261–5.

    Article  PubMed  Google Scholar 

  32. Hall FM. Papillary lesions of the breast. Radiology. 2006;243:300.

    Article  Google Scholar 

  33. March DE, Coughlin BF, Barham RB, et al. Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device—initial experience. Radiology. 2003;227:549–55.

    Article  PubMed  Google Scholar 

  34. Dennis MA, Parker S, Kaske TI, Stavros AT, Camp J. Incidental treatment of nipple discharge caused by benign intraductal papilloma through diagnostic Mammotome biopsy. AJR Am J Roentgenol. 2000;174:1263–8.

    PubMed  CAS  Google Scholar 

  35. Jackman RJ, Birdwell RL, Ikeda DM. Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision? Radiology. 2002;224:548–54.

    Article  PubMed  Google Scholar 

  36. Brenner RJ, Jackman RJ, Parker SH, et al. Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR Am J Roentgenol. 2002;179:1179–84.

    PubMed  Google Scholar 

  37. Comstock CE. US-guided interventional procedures. In: Feig SA, editor. Breast imaging: RSNA categorical course in diagnostic radiology. Oak Brook, IL: Radiological Society of North America; 2005. p. 155–68.

  38. Shah VI, Flowers CI, Douglas-Jones AG, Dallimore NS, Rashid M. Immunohistochemistry increases the accuracy of diagnosis of benign papillary lesions in breast core needle biopsy specimens. Histopathology. 2006;48:683–91.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul, Korea

    Jung Min Chang MD, Woo Kyung Moon MD & Nariya Cho MD

  2. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

    Jung Min Chang MD, Woo Kyung Moon MD & Nariya Cho MD

  3. Department of Surgery, Seoul National University Hospital, Seoul, Korea

    Wonsik Han MD & Dong-Young Noh MD

  4. Department of Pathology, Seoul National University Hospital, Seoul, Korea

    In-Ae Park MD & Eun-Jung Jung MD

Authors
  1. Jung Min Chang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wonsik Han MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Woo Kyung Moon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nariya Cho MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dong-Young Noh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. In-Ae Park MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eun-Jung Jung MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Woo Kyung Moon MD.

Additional information

Jung Min Chang and Wonsik Han contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chang, J.M., Han, W., Moon, W.K. et al. Papillary Lesions Initially Diagnosed at Ultrasound-guided Vacuum-assisted Breast Biopsy: Rate of Malignancy Based on Subsequent Surgical Excision. Ann Surg Oncol 18, 2506–2514 (2011). https://doi.org/10.1245/s10434-011-1617-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-1617-3

Keywords

Search

Navigation