Papillary Lesions Initially Diagnosed at Ultrasound-guided Vacuum-assisted Breast Biopsy: Rate of Malignancy Based on Subsequent Surgical Excision
- 486 Downloads
To prospectively determine the rate of malignancy after surgery in papillary lesions initially diagnosed at ultrasound (US)-guided 11-gauge vacuum-assisted breast biopsies.
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.
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.
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.
KeywordsPapilloma Core Needle Biopsy Atypical Ductal Hyperplasia Nipple Discharge Papillary Lesion
- 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.
- 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.Google Scholar