Annals of Surgical Oncology

, Volume 20, Issue 1, pp 94–101 | Cite as

Nonmalignant Breast Papillary Lesions at Core-Needle Biopsy: A Meta-analysis of Underestimation and Influencing Factors

  • Xin Wen
  • Wen ChengEmail author
Breast Oncology



The clinical management of nonmalignant breast papillary lesions diagnosed at core-needle biopsy (CNB) is controversial. A meta-analysis was performed to evaluate pooled estimates of the underestimation of malignant papillary lesions (which were diagnosed as nonmalignant lesions at CNB) and to survey factors that affect that underestimation.


We searched for studies that provided data on CNB underestimates of malignant breast papillary lesions indexed in PUBMED. The pooled estimate for underestimation was calculated. The association between each variable and underestimation was investigated using either random- or fixed-effects logistic modeling.


A total of 34 studies, which included 2,236 nonmalignant breast papillary lesions diagnosed at CNB and histologically examined after surgical excision, were included. Of these, 346 nonmalignant lesions at CNB were upgraded to malignant after surgical excision. The pooled estimate for the percentage of underestimation was 15.7 % [95 % confidence interval (CI): 12.8–18.5 %]. The factors associated with higher underestimation included atypical papillary lesions (P < 0.001), positive mammographic findings (P = 0.022), and article publication year before 2005 (P < 0.05).


It is recommended that atypical papillary lesions at CNB undergo surgical excision, and it is reasonable to follow patients with benign lesions with serial imaging. Lesion type, mammographic findings, and article publication year were significantly associated with underestimation.


Papillary Lesion Mammographic Finding Intraductal Papilloma Atypical Lesion Nonmalignant Lesion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Ueng SH, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast: a review. Arch Pathol Lab Med. 2009;133:893–907.PubMedGoogle Scholar
  2. 2.
    Cheng TY, Chen CM, Lee MY, Lin KJ, Hung CF, Yang PS, 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.PubMedCrossRefGoogle Scholar
  3. 3.
    Carder PJ, Khan T, Burrows P, Sharma N. Large volume “mammotome” biopsy may reduce the need for diagnostic surgery in papillary lesions of the breast. J Clin Pathol. 2008;61:928–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Hayes BD, O’Doherty A, Quinn CM. Correlation of needle core biopsy with excision histology in screen-detected B3 lesions: the Merrion Breast Screening Unit experience. J Clin Pathol. 2009;62:1136–40.PubMedCrossRefGoogle Scholar
  5. 5.
    EI-Sayed ME, Rakha EA, Reed J, Lee AH, Evans AJ, Ellis IO. Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Histopathology. 2008;53:650–7.CrossRefGoogle Scholar
  6. 6.
    Dillon MF, McDermott EW, Hill AD, O’Doherty A, O’Hiqqins N, Quinn CM. Predictive value of breast lesions of “uncertain malignant potential” and “suspicious for malignancy” determined by needle core biopsy. Ann Surg Oncol. 2007;14:704–11.PubMedCrossRefGoogle Scholar
  7. 7.
    Houssami N, Ciatto S, Bilous M, Vezzosi V, Bianchi S. Borderline breast core needle histology: predictive values for malignancy in lesions of uncertain malignant potential (B3). Br J Cancer. 2007;96:1253–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Carder PJ, Garvican J, Haiqh I, Liston JC. Needle core biopsy can reliably distinguish between benign and malignant papillary lesions of the breast. Histopathology. 2005;46:320–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Puglisi F, Zuiani C, Bazzocchi M, Valent F, Aprile G, Pertoldi B, et al. Role of mammography, ultrasound and large core biopsy in the diagnostic evaluation of papillary breast lesions. Oncology. 2003;65:311–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Renshaw AA, Derhaqopian RP, Tizol-Blanco DM, Gould EW. Papillomas and atypical papillomas in breast core needle biopsy specimens. Am J Clin Pathol. 2004;122:217–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Irfan K, Brem RF. Surgical and mammographic follow-up of papillary lesions and atypical lobular hyperplasia diagnosed with stereotactic vacuum-assisted biopsy. Breast J. 2002;8:230–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Brennan, Turner, Ciatto, Marinovich, French, Macaskill, et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 2011;260:119–28.PubMedCrossRefGoogle Scholar
  13. 13.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.PubMedCrossRefGoogle Scholar
  14. 14.
    National Health and Medical Research Council. How to review the evidence: systematic identification and review of the scientific literature. Canberra, Australia: National Health and Medical Research Council. 2000;57–63.Google Scholar
  15. 15.
    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;8:206–211.PubMedCrossRefGoogle Scholar
  16. 16.
    Rosen EL, Bentley RC, Baker JA, Soo MS. Imaging-guided core needle biopsy of papillary lesions of the breast. Am J Roentgenol. 2002;179:1185–92.Google Scholar
  17. 17.
    Shin HJ, Kim HH, Kim SM, Yang HR, Sohn JH, Kwon GY, 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.CrossRefGoogle Scholar
  18. 18.
    Lam WW, Chu WC, Tang AP, Tse G, Ma TK. Role of radiologic features in the management of papillary lesions of the breast. Am J Roentgenol. 2006;196:1322–7.CrossRefGoogle Scholar
  19. 19.
    Liberman L, Bracero N, Vuolo MA, Dershaw DD, Morris EA, Abramson AF, et al. Percutaneous large-core biopsy of papillary breast lesions. Am J Roentgenol. 1999;172:331–7.Google Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    Kil WH, Cho EY, Kim JH, Nam SJ, Yang JH. Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy? Breast. 2008;17:258–62.PubMedCrossRefGoogle Scholar
  22. 22.
    Chang JM, Moon WK, Cho N, Han W, Noh DY, Park IA, et al. Management of ultrasonographically detected benign papillomas of the breast at core needle biopsy. Am J Roentgenol. 2011;196:723–9.CrossRefGoogle Scholar
  23. 23.
    Valdes EK, Tartter PI, Genelus-Dominique E, Guilbaud DA, Rosenbaum-Smith S, Estabrook A. Significance of papillary lesions at percutaneous breast biopsy. Ann Surg Oncol. 2006;13:480–2.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    Kim MJ, Kim SI, Youk JH, Moon HJ, Kwak JY, Park BW, et al. The diagnosis of non-malignant papillary lesions of the breast: comparison of ultrasound-guided automated gun biopsy and vacuum-assisted removal. Clin Radiol. 2011;66:530–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Bode MK, Rissanen T, Apaja-Sarkkinen M. Ultrasonography-guided core needle biopsy in differential diagnosis of papillary breast tumors. Acta Radiol. 2009;7:722–9.CrossRefGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    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.CrossRefGoogle Scholar
  29. 29.
    Agoff SN, Lawton TJ. Papillary lesions of the breast with and without atypical ductal hyperplasia. Am J Clin Pathol. 2004;122:440–3.PubMedCrossRefGoogle Scholar
  30. 30.
    Philpotts LE, Shaheen NA, Jain KS, Carter D, Lee CH. Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology. 2000;216:831–7.PubMedGoogle Scholar
  31. 31.
    Skandarajah AR, Field L, Yuen Larn Mou A, Buchanan M, Evans J, Hart S, et al. Benign papilloma on core biopsy requires surgical excision. Ann Surg Oncol. 2008;15:2272–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Arora N, Hill C, Hoda SA, Rosenblatt R, Pigalarga R, Tousimis EA. Clinicopathologic features of papillary lesions on core needle biopsy of the breast predictive of malignancy. Am J Surg. 2007;194:444–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Masood S, Loya A, Khalbuss W. Is core needle biopsy superior to fine-needle aspiration biopsy in the diagnosis of papillary breast lesions? Diagn Cytopathol. 2002;28:329–34.CrossRefGoogle Scholar
  34. 34.
    Bennett LE, Ghate SV, Bentley R, Baker JA. Is surgical excision of core biopsy proven benign papillomas of the breast necessary? Acad Radiol. 2010;17:553–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Bernik SF, Troob S, Ying BL, Simpson SA, Axelrod DM, Siegel B, et al. Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up. Am J Surg. 2009;197:473–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Tse GM, Tan PH, Lacambra MD, Jara-Lazaro AR, Chan SK, Lui PC, et al. Papillary lesions of the breast accuracy of core biopsy. Histopathology. 2010;56:481–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Ashkenazi I, Ferrer K, Sekosan M, Marcus E, Bork J, Aiti T, et al. Papillary lesions of the breast discovered on percutaneous large core and vacuum-assisted biopsies: reliability of clinical and pathological parameters in identifying benign lesions. Am J Surg. 2007;194:183–8.PubMedCrossRefGoogle Scholar
  38. 38.
    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.CrossRefGoogle Scholar
  39. 39.
    Mercado CL, Hamele-Bena D, Singer C, Koenigsberg T, Pile-Spellman E, Higgins H, et al. Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy. Radiology. 2001;221:650–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Liberman L, Tornos C, Huzjan R, Bartella L, Morris EA, Dershaw DD. Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? Am J Roentgenol. 2006;186:1328–34.CrossRefGoogle Scholar
  41. 41.
    Sakr R, Rouzier R, Salem C, Antoine M, Chopier J, Darai E, et al. Risk of breast cancer associated with papilloma. J Cancer Surg. 2008;34:1304–8.Google Scholar
  42. 42.
    Tseng HS, Chen YL, Chen ST, Wu YC, Kuo SJ, Chen LS, et al. The management of papillary lesion of the breast by core needle biopsy. J Cancer Surg. 2009;35:21–4.Google Scholar
  43. 43.
    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.PubMedCrossRefGoogle Scholar
  44. 44.
    Jung SY, Kang HS, Kwon Y, Min SY, Kim EA, Ko KL, et al. Risk factors for malignancy in benign papillomas of the breast on core needle biopsy. World J Surg. 2010;34:261–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Sohn V, Keylock J, Arthurs Z, Wilson A, Herbert G, Perry J, et al. Breast papillomas in the era of percutaneous needle biopsy. Ann Surg Oncol. 2007;14:2979–84.PubMedCrossRefGoogle Scholar
  46. 46.
    Richter-Ehrenstein C, Tombokan F, Fallenberg EM, Schneider A, Denkert C. Intraductal papillomas of the breast: diagnosis and management of 151 patients. Breast. 2011;5:1–4.Google Scholar
  47. 47.
    Jakate K, De Brot M, Goldberg F, Muradali D, O’Malley FP, Mulligan AM. Papillary lesions of the breast: impact of breast pathology subspecialization on core biopsy and excision diagnoses. Am J Surg Pathol. 2012;36:544–51.PubMedCrossRefGoogle Scholar
  48. 48.
    Rizzo M, Linebarger J, Lowe MC, Pan L, Gabram SG, Vasquez L, 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.PubMedCrossRefGoogle Scholar
  49. 49.
    Chang JM, Moon WK, Cho N, Han W, Noh DY, Park IA, 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.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  1. 1.Department of UltrasoundThe Third Affiliated Hospital of Harbin Medical UniversityNangang District, HarbinChina

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