Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2011

01-09-2011 | Breast Oncology

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

Authors: Jung Min Chang, MD, Wonsik Han, MD, Woo Kyung Moon, MD, Nariya Cho, MD, Dong-Young Noh, MD, In-Ae Park, MD, Eun-Jung Jung, MD

Published in: Annals of Surgical Oncology | Issue 9/2011

Login to get access

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.
Literature
1.
Parker SH, Burbank F, Jackman RJ, et al. Percutaneous large-core breast biopsy: a multi-institutional study. Radiology. 1994;193:359–64.PubMed
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.PubMedCrossRef
3.
Ueng SH, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast. Arch Pathol Lab Med. 2009;133:893–907.PubMed
4.
Philpotts LE. Percutaneous breast biopsy: emerging techniques and continuing controversies. Semin Roentgenol. 2007;42:218–27.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.CrossRef
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
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.PubMedCrossRef
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
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.PubMedCrossRef
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
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.CrossRef
19.
Maxwell AJ. Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience. Clin Radiol. 2009;64:801–6.PubMedCrossRef
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
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.
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.
23.
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.PubMedCrossRef
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
26.
Berg WA. Image-guided breast biopsy and management of high-risk lesions. Radiol Clin North Am. 2004;42:935–46.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
32.
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.PubMedCrossRef
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
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.PubMedCrossRef
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
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.PubMedCrossRef
Metadata
Title
Papillary Lesions Initially Diagnosed at Ultrasound-guided Vacuum-assisted Breast Biopsy: Rate of Malignancy Based on Subsequent Surgical Excision
Authors
Jung Min Chang, MD
Wonsik Han, MD
Woo Kyung Moon, MD
Nariya Cho, MD
Dong-Young Noh, MD
In-Ae Park, MD
Eun-Jung Jung, MD
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 9/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1617-3

Other articles of this Issue 9/2011

Annals of Surgical Oncology 9/2011 Go to the issue

Melanomas

Quality Assurance Parameters and Predictors of Outcome for Ilioinguinal and Inguinal Dissection in a Contemporary Melanoma Patient Population

Healthcare Policy and Outcomes

American Board of Surgery Certificate in Complex General Surgical Oncology: A Reality

Breast Oncology

To Cut Is to Cure: Can We Really Apply Z11 in Practice?

Breast Oncology

The Choice for Breast Cancer Surgery: Can Women Accurately Predict Postoperative Quality of Life and Disease-Related Stigma?

Gynecologic Oncology

Robotics Versus Laparoscopic Radical Hysterectomy with Lymphadenectomy in Patients with Early Cervical Cancer: A Multicenter Study

Urologic Oncology

Surgical Caseload is an Important Determinant of Continent Urinary Diversion Rate at Radical Cystectomy: A Population-Based Study