Skip to main content

Advertisement

SpringerLink
Log in

Asymptomatic Benign Papilloma Without Atypia Diagnosed at Ultrasonography-Guided 14-Gauge Core Needle Biopsy: Which Subgroup can be Managed by Observation?

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

Abstract

Background

For asymptomatic benign papillomas detected at ultrasonography-guided 14-gauge core-needle biopsy (US–CNB), the decision to perform excision versus observation has been a topic of debate. We sought to determine which subgroup of asymptomatic benign papillomas without atypia diagnosed at US–CNB can be safely managed by observation versus immediate excision.

Materials

Overall, 230 asymptomatic benign papillomas in 197 women (mean age 46.6 ± 9.5 years; range 22–78), diagnosed at US–CNB using immunohistochemistry staining when needed and then managed by surgery (n = 144) or vacuum-assisted excision (VAE) with at least 12 months of follow-up after benign VAE results (n = 86) were included in this study. The upgrade rate to malignancy was calculated. Clinical and radiological variables, including age, size, Breast Image Reporting and Data System (BI–RADS) category, and imaging–pathology correlation were evaluated to find associations with malignancy using multivariate analysis.

Results

The upgrade rate to malignancy was 2.6 % (6 of 230): four were ductal carcinomas in situ and two were 1.5- and 9-mm-sized invasive ductal carcinomas without lymph node metastasis. The upgrade rates of papillomas with a BI–RADS category 3–4a and imaging–pathology concordance were 1.4 and 1.8 %, respectively. Category 4b–5 and imaging–pathology discordance were independently associated with malignancy, with upgrade rates of 13 and 50 %, respectively. Age and lesion size were not associated with malignancy.

Conclusion

Asymptomatic benign papillomas with probable benign or low suspicious US features or imaging–pathology concordance can be followed-up as opposed to immediate excision.

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

Similar content being viewed by others

References

  1. Mulligan AM, O’Malley FP. Papillary lesions of the breast: a review. Adv Anat Pathol. 2007;14:108–19.

    Article  PubMed  Google Scholar 

  2. Ueng S-H, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast: a review. Arch Pathol Lab Med. 2009;133:893–907.

    PubMed  Google Scholar 

  3. 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 

  4. Mcghan LJ, Pockaj BA, Wasif N, Giurescu ME, Mccullough AE, Gray RJ. Papillary lesions on core breast biopsy: excisional biopsy for all patients? Am Surg. 2013;79:1238–42.

    PubMed  Google Scholar 

  5. Moritani S, Ichihara S, Hasegawa M, et al. Uniqueness of ductal carcinoma in situ of the breast concurrent with papilloma: implications from a detailed topographical and histopathological study of 50 cases treated by mastectomy and wide local excision. Histopathology. 2013;63:407–17.

    Article  PubMed  Google Scholar 

  6. Bode M, Rissanen T, Apaja-Sarkkinen M. Ultrasonography-guided core needle biopsy in differential diagnosis of papillary breast tumors. Acta Radiol. 2009;50:722–9.

    Article  CAS  PubMed  Google Scholar 

  7. Ko ES, Cho N, Cha JH, Park JS, Kim SM, Moon WK. Sonographically-guided 14-gauge core needle biopsy for papillary lesions of the breast. Korean J Radiol. 2007;8:206–11.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tseng H, Chen Y, Chen S, et al. The management of papillary lesion of the breast by core needle biopsy. Eur J Surg Oncol. 2009;35:21–4.

    Article  CAS  PubMed  Google Scholar 

  9. Kil W-H, Cho EY, Kim JH, Nam S-J, Yang J-H. Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy? Breast. 2008;17:258–62.

    Article  PubMed  Google Scholar 

  10. 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. Am J Roentgenol. 2008;190:630–6.

    Article  Google Scholar 

  11. Cheng T-Y, Chen C-M, Lee M-Y, 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 

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

    Article  Google Scholar 

  13. Georgian-Smith D, Lawton TJ. Controversies on the management of high-risk lesions at core biopsy from a radiology/pathology perspective. Radiol Clin North Am. 2010;48:999–1012.

    Article  PubMed  Google Scholar 

  14. Ivan D, Selinko V, Sahin AA, Sneige N, Middleton LP. Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy. Mod Pathol. 2004;17:165–71.

    Article  PubMed  Google Scholar 

  15. Youk JH, Kim E-K, Kwak JY, Son EJ, Park B-W, Kim S-I. Benign papilloma without atypia diagnosed at US-guided 14-gauge core-needle biopsy: clinical and US features predictive of upgrade to malignancy. Radiology. 2011;258:81–8.

    Article  PubMed  Google Scholar 

  16. Swapp RE, Glazebrook KN, Jones KN, et al. Management of benign intraductal solitary papilloma diagnosed on core needle biopsy. Ann Surg Oncol. 2013;20:1900–5.

    Article  PubMed  Google Scholar 

  17. Nakhlis F, Ahmadiyeh N, Lester S, Raza S, Lotfi P, Golshan M. Papilloma on core biopsy: excision vs. observation. Ann Surg Oncol. 2015;22:1479–82.

    Article  PubMed  Google Scholar 

  18. Fu C-Y, Chen T-W, Hong Z-J, et al. Papillary breast lesions diagnosed by core biopsy require complete excision. Eur J Surg Oncol. 2012;38:1029–35.

    Article  PubMed  Google Scholar 

  19. Shouhed D, Amersi FF, Spurrier R, et al. Intraductal papillary lesions of the breast: clinical and pathological correlation. Am Surg. 2012;78:1161–5.

    PubMed  Google Scholar 

  20. Skandarajah AR, Field L, Mou AYL, et al. Benign papilloma on core biopsy requires surgical excision. Ann Surg Oncol. 2008;15:2272–7.

    Article  PubMed  Google Scholar 

  21. Rizzo M, Linebarger J, Lowe MC, et al. Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up. J Am Coll Surg. 2012;214:280–7.

    Article  PubMed  Google Scholar 

  22. Nakhlis F, Ahmadiyeh N, Lester S, Raza S, Lotfi P, Golshan M. Papilloma on core biopsy: excision vs. observation. Ann Surg Oncol. 2015;22(5):1479–82.

    Article  PubMed  Google Scholar 

  23. Agoff SN, Lawton TJ. Papillary lesions of the breast with and without atypical ductal hyperplasia can we accurately predict benign behavior from core needle biopsy? Am J Clin Pathol. 2004;122:440–3.

    Article  PubMed  Google Scholar 

  24. 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 

  25. Sakorafas G. Nipple discharge: current diagnostic and therapeutic approaches. Cancer Treat Rev. 2001;27:275–82.

    Article  CAS  PubMed  Google Scholar 

  26. Nayak A, Carkaci S, Gilcrease MZ, et al. Benign papillomas without atypia diagnosed on core needle biopsy: experience from a single institution and proposed criteria for excision. Clin Breast Cancer. 2013;13:439–49.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Berg WA, Blume JD, Cormack JB, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA. 2008;299:2151–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Carder P, Garvican J, Haigh I, Liston J. Needle core biopsy can reliably distinguish between benign and malignant papillary lesions of the breast. Histopathology. 2005;46:320–7.

    Article  CAS  PubMed  Google Scholar 

  29. Furuya C, Kawano H, Yamanouchi T, Oga A, Ueda J, Takahashi M. Combined evaluation of CK5/6, ER, p63, and MUC3 for distinguishing breast intraductal papilloma from ductal carcinoma in situ. Pathol Int. 2012;62:381–90.

    Article  PubMed  Google Scholar 

  30. Grin A, O’Malley FP, Mulligan AM. Cytokeratin 5 and estrogen receptor immunohistochemistry as a useful adjunct in identifying atypical papillary lesions on breast needle core biopsy. Am J Surg Pathol. 2009;33:1615–23.

    Article  PubMed  Google Scholar 

  31. Koo JS, Han K, Kim MJ, Moon HJ, Kim E-K, Park B-W. Can additional immunohistochemistry staining replace the surgical excision for the diagnosis of papillary breast lesions classified as benign on 14-gage core needle biopsy? Breast Cancer Res Treat. 2013;137:797–806.

    Article  PubMed  Google Scholar 

  32. American College of Radiology. Breast imaging reporting and data system (BI-RADS). 4th ed. Reston: American College of Radiology; 2003.

    Google Scholar 

  33. Salkowski LR, Fowler AM, Burnside ES, Sisney GA. Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology. 2011;258:380–7.

    Article  PubMed  Google Scholar 

  34. Youk JH, Jung I, Kim E-K, et al. US follow-up protocol in concordant benign result after US-guided 14-gauge core needle breast biopsy. Breast Cancer Research Treat. 2012;132:1089–97.

    Article  Google Scholar 

  35. Moon HJ, Jung I, Youk JH, Kim MJ, Kim E-K. Short-term follow-up in 6 months is unnecessary for asymptomatic breast lesions with benign concordant results obtained at ultrasonography-guided 14-gauge core needle biopsy. Am J Surg. 2016;211:152–8.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  37. Youk JH, Kim MJ, Son EJ, Kwak JY, Kim E-K. US-guided vacuum-assisted percutaneous excision for management of benign papilloma without atypia diagnosed at US-guided 14-gauge core needle biopsy. Ann Surg Oncol. 2012;19:922–8.

    Article  PubMed  Google Scholar 

  38. Kalof A, Tam D, Beatty B, Cooper K. Immunostaining patterns of myoepithelial cells in breast lesions: a comparison of CD10 and smooth muscle myosin heavy chain. J Clin Pathol. 2004;57:625–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32–5.

    Article  CAS  PubMed  Google Scholar 

  40. Youk JH, Kim E-K, Kim MJ, et al. Concordant or discordant? Imaging-pathology correlation in a sonography-guided core needle biopsy of a breast lesion. Korean J Radiol. 2011;12:232–40.

    Article  PubMed  PubMed Central  Google Scholar 

  41. SL Z, KY L. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42(1):121–30.

    Article  Google Scholar 

  42. Jung S-Y, Kang H-S, 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 

  43. Sakr R, Rouzier R, Salem C, et al. Risk of breast cancer associated with papilloma. Eur J Surg Oncol. 2008;34:1304–8.

    Article  CAS  PubMed  Google Scholar 

  44. Wen X, Cheng W. Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol. 2013;20:94–101.

    Article  PubMed  Google Scholar 

  45. Hall FM. Screening mammography guidelines: an alternative proactive approach. Radiology. 2014;273:646–51.

    Article  PubMed  Google Scholar 

  46. Graf O, Helbich TH, Hopf G, Graf C, Sickles EA. Probably benign breast masses at US: is follow-up an acceptable alternative to biopsy? Radiology. 2007;244:87–93.

    Article  PubMed  Google Scholar 

  47. Sickles EA. Probably benign breast lesions: when should follow-up be recommended and what is the optimal follow-up protocol? Radiology. 1999;213:11–4.

    Article  CAS  PubMed  Google Scholar 

  48. 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 

  49. Shah V, Flowers C, Douglas‐Jones A, Dallimore N, Rashid M. Immunohistochemistry increases the accuracy of diagnosis of benign papillary lesions in breast core needle biopsy specimens. Histopathology. 2006;48:683–91.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea

    Soo-Yeon Kim MD, Eun-Kyung Kim MD, PhD, Min Jung Kim MD, PhD, Jung Hyun Yoon MD, PhD & Hee Jung Moon MD, PhD

  2. Biostatistics Collaboration Unit, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Hye Sun Lee MS

  3. Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Ja Seung Koo MD, PhD

Authors
  1. Soo-Yeon Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eun-Kyung Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hye Sun Lee MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Min Jung Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jung Hyun Yoon MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ja Seung Koo MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hee Jung Moon MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hee Jung Moon MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, SY., Kim, EK., Lee, H.S. et al. Asymptomatic Benign Papilloma Without Atypia Diagnosed at Ultrasonography-Guided 14-Gauge Core Needle Biopsy: Which Subgroup can be Managed by Observation?. Ann Surg Oncol 23, 1860–1866 (2016). https://doi.org/10.1245/s10434-016-5144-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5144-0

Keywords

Search

Navigation