Percutaneous biopsy of papillary lesions of the breast: Accuracy of pathologic diagnosis

Rachel F. Brem, Khanh Tran, Jocelyn Rapelyea, Katherine H. Michener, Gilat Zisman, Kevin Mohtashemi, Katherine Berezowski

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: The purpose of this study was to determine the accuracy of the pathologic diagnosis of papillary breast lesions when evaluated by percutaneous biopsy. MATERIALS AND METHODS: A total of 2307 consecutive breast lesions, diagnosed by percutaneous biopsy, were retrospectively reviewed. Of these, 45 lesions were papillary lesions; 15 of the 45 cases were lost to follow-up or had not had imaging follow-up and were excluded. The remaining 30 papillary lesions constituted the study population. Subsequent surgical excision or imaging follow-up (a minimum of 6 months) was performed and correlated with the initial diagnoses. RESULTS: Of the 30 lesions, 11 intraductal papillomas were diagnosed with stereotactic vacuum assisted biopsy (SVAB). Surgical excision was performed on four lesions (36.4%). Pathologic findings in all four lesions (100%) were benign. Of the 13 papillary lesions diagnosed with ultrasound-guided core needle biopsy, three (23.1%) demonstrated papillomatosis. Subsequent surgical excision was performed on 11 (84.6%) of the 13 papillary lesions, including two of the three papillomatosis. Pathology was benign in all. The two (18.2%) other lesions, initially diagnosed as papillomatosis and benign papilloma, were a fibroadenoma and organizing papillomatosis, respectively, at surgery. The six lesions that were sampled with fine needle aspiration (FNA) demonstrated intraductal papillary lesions, two (33.3%) of which had cytologic atypia. Surgical excision was performed on all six (100%) with benign breast tissue in four (66.7%) including one of the lesions demonstrating atypia. The two (33.3%) other lesions demonstrated high-grade invasive papillary carcinoma with in-situ components. CONCLUSION: Surgical excision is warranted when a percutaneous breast biopsy demonstrates a papillary lesion with atypia or when there is radiologic-pathologic discordance. Otherwise, these lesions can be followed conservatively. Furthermore, for improved diagnostic accuracy, indeterminate intraductal lesions should undergo biopsy with CNB or stereotactic vacuum assisted biopsy and not fine needle aspiration. The cytologic diagnosis of papillary lesions is considered only preliminary by fine needle aspiration, and should await surgical resection and histologic examination to further classify these lesions.

Original languageEnglish (US)
Pages (from-to)157-162
Number of pages6
JournalJournal of Women's Imaging
Volume7
Issue number4
DOIs
StatePublished - Dec 2005
Externally publishedYes

Fingerprint

Papilloma
Breast
Biopsy
Fine Needle Biopsy
Vacuum
Intraductal Papilloma
Large-Core Needle Biopsy
Fibroadenoma
Papillary Carcinoma
Lost to Follow-Up
Carcinoma in Situ
Pathology
Population

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

Cite this

Brem, R. F., Tran, K., Rapelyea, J., Michener, K. H., Zisman, G., Mohtashemi, K., & Berezowski, K. (2005). Percutaneous biopsy of papillary lesions of the breast: Accuracy of pathologic diagnosis. Journal of Women's Imaging, 7(4), 157-162. https://doi.org/10.1097/01.jwi.0000200319.22842.2e

Percutaneous biopsy of papillary lesions of the breast : Accuracy of pathologic diagnosis. / Brem, Rachel F.; Tran, Khanh; Rapelyea, Jocelyn; Michener, Katherine H.; Zisman, Gilat; Mohtashemi, Kevin; Berezowski, Katherine.

In: Journal of Women's Imaging, Vol. 7, No. 4, 12.2005, p. 157-162.

Research output: Contribution to journalArticle

Brem, RF, Tran, K, Rapelyea, J, Michener, KH, Zisman, G, Mohtashemi, K & Berezowski, K 2005, 'Percutaneous biopsy of papillary lesions of the breast: Accuracy of pathologic diagnosis', Journal of Women's Imaging, vol. 7, no. 4, pp. 157-162. https://doi.org/10.1097/01.jwi.0000200319.22842.2e
Brem, Rachel F. ; Tran, Khanh ; Rapelyea, Jocelyn ; Michener, Katherine H. ; Zisman, Gilat ; Mohtashemi, Kevin ; Berezowski, Katherine. / Percutaneous biopsy of papillary lesions of the breast : Accuracy of pathologic diagnosis. In: Journal of Women's Imaging. 2005 ; Vol. 7, No. 4. pp. 157-162.
@article{5e3889e972b141a696666aa4107cac8c,
title = "Percutaneous biopsy of papillary lesions of the breast: Accuracy of pathologic diagnosis",
abstract = "OBJECTIVE: The purpose of this study was to determine the accuracy of the pathologic diagnosis of papillary breast lesions when evaluated by percutaneous biopsy. MATERIALS AND METHODS: A total of 2307 consecutive breast lesions, diagnosed by percutaneous biopsy, were retrospectively reviewed. Of these, 45 lesions were papillary lesions; 15 of the 45 cases were lost to follow-up or had not had imaging follow-up and were excluded. The remaining 30 papillary lesions constituted the study population. Subsequent surgical excision or imaging follow-up (a minimum of 6 months) was performed and correlated with the initial diagnoses. RESULTS: Of the 30 lesions, 11 intraductal papillomas were diagnosed with stereotactic vacuum assisted biopsy (SVAB). Surgical excision was performed on four lesions (36.4{\%}). Pathologic findings in all four lesions (100{\%}) were benign. Of the 13 papillary lesions diagnosed with ultrasound-guided core needle biopsy, three (23.1{\%}) demonstrated papillomatosis. Subsequent surgical excision was performed on 11 (84.6{\%}) of the 13 papillary lesions, including two of the three papillomatosis. Pathology was benign in all. The two (18.2{\%}) other lesions, initially diagnosed as papillomatosis and benign papilloma, were a fibroadenoma and organizing papillomatosis, respectively, at surgery. The six lesions that were sampled with fine needle aspiration (FNA) demonstrated intraductal papillary lesions, two (33.3{\%}) of which had cytologic atypia. Surgical excision was performed on all six (100{\%}) with benign breast tissue in four (66.7{\%}) including one of the lesions demonstrating atypia. The two (33.3{\%}) other lesions demonstrated high-grade invasive papillary carcinoma with in-situ components. CONCLUSION: Surgical excision is warranted when a percutaneous breast biopsy demonstrates a papillary lesion with atypia or when there is radiologic-pathologic discordance. Otherwise, these lesions can be followed conservatively. Furthermore, for improved diagnostic accuracy, indeterminate intraductal lesions should undergo biopsy with CNB or stereotactic vacuum assisted biopsy and not fine needle aspiration. The cytologic diagnosis of papillary lesions is considered only preliminary by fine needle aspiration, and should await surgical resection and histologic examination to further classify these lesions.",
author = "Brem, {Rachel F.} and Khanh Tran and Jocelyn Rapelyea and Michener, {Katherine H.} and Gilat Zisman and Kevin Mohtashemi and Katherine Berezowski",
year = "2005",
month = "12",
doi = "10.1097/01.jwi.0000200319.22842.2e",
language = "English (US)",
volume = "7",
pages = "157--162",
journal = "Journal of Women's Imaging",
issn = "1084-824X",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Percutaneous biopsy of papillary lesions of the breast

T2 - Accuracy of pathologic diagnosis

AU - Brem, Rachel F.

AU - Tran, Khanh

AU - Rapelyea, Jocelyn

AU - Michener, Katherine H.

AU - Zisman, Gilat

AU - Mohtashemi, Kevin

AU - Berezowski, Katherine

PY - 2005/12

Y1 - 2005/12

N2 - OBJECTIVE: The purpose of this study was to determine the accuracy of the pathologic diagnosis of papillary breast lesions when evaluated by percutaneous biopsy. MATERIALS AND METHODS: A total of 2307 consecutive breast lesions, diagnosed by percutaneous biopsy, were retrospectively reviewed. Of these, 45 lesions were papillary lesions; 15 of the 45 cases were lost to follow-up or had not had imaging follow-up and were excluded. The remaining 30 papillary lesions constituted the study population. Subsequent surgical excision or imaging follow-up (a minimum of 6 months) was performed and correlated with the initial diagnoses. RESULTS: Of the 30 lesions, 11 intraductal papillomas were diagnosed with stereotactic vacuum assisted biopsy (SVAB). Surgical excision was performed on four lesions (36.4%). Pathologic findings in all four lesions (100%) were benign. Of the 13 papillary lesions diagnosed with ultrasound-guided core needle biopsy, three (23.1%) demonstrated papillomatosis. Subsequent surgical excision was performed on 11 (84.6%) of the 13 papillary lesions, including two of the three papillomatosis. Pathology was benign in all. The two (18.2%) other lesions, initially diagnosed as papillomatosis and benign papilloma, were a fibroadenoma and organizing papillomatosis, respectively, at surgery. The six lesions that were sampled with fine needle aspiration (FNA) demonstrated intraductal papillary lesions, two (33.3%) of which had cytologic atypia. Surgical excision was performed on all six (100%) with benign breast tissue in four (66.7%) including one of the lesions demonstrating atypia. The two (33.3%) other lesions demonstrated high-grade invasive papillary carcinoma with in-situ components. CONCLUSION: Surgical excision is warranted when a percutaneous breast biopsy demonstrates a papillary lesion with atypia or when there is radiologic-pathologic discordance. Otherwise, these lesions can be followed conservatively. Furthermore, for improved diagnostic accuracy, indeterminate intraductal lesions should undergo biopsy with CNB or stereotactic vacuum assisted biopsy and not fine needle aspiration. The cytologic diagnosis of papillary lesions is considered only preliminary by fine needle aspiration, and should await surgical resection and histologic examination to further classify these lesions.

AB - OBJECTIVE: The purpose of this study was to determine the accuracy of the pathologic diagnosis of papillary breast lesions when evaluated by percutaneous biopsy. MATERIALS AND METHODS: A total of 2307 consecutive breast lesions, diagnosed by percutaneous biopsy, were retrospectively reviewed. Of these, 45 lesions were papillary lesions; 15 of the 45 cases were lost to follow-up or had not had imaging follow-up and were excluded. The remaining 30 papillary lesions constituted the study population. Subsequent surgical excision or imaging follow-up (a minimum of 6 months) was performed and correlated with the initial diagnoses. RESULTS: Of the 30 lesions, 11 intraductal papillomas were diagnosed with stereotactic vacuum assisted biopsy (SVAB). Surgical excision was performed on four lesions (36.4%). Pathologic findings in all four lesions (100%) were benign. Of the 13 papillary lesions diagnosed with ultrasound-guided core needle biopsy, three (23.1%) demonstrated papillomatosis. Subsequent surgical excision was performed on 11 (84.6%) of the 13 papillary lesions, including two of the three papillomatosis. Pathology was benign in all. The two (18.2%) other lesions, initially diagnosed as papillomatosis and benign papilloma, were a fibroadenoma and organizing papillomatosis, respectively, at surgery. The six lesions that were sampled with fine needle aspiration (FNA) demonstrated intraductal papillary lesions, two (33.3%) of which had cytologic atypia. Surgical excision was performed on all six (100%) with benign breast tissue in four (66.7%) including one of the lesions demonstrating atypia. The two (33.3%) other lesions demonstrated high-grade invasive papillary carcinoma with in-situ components. CONCLUSION: Surgical excision is warranted when a percutaneous breast biopsy demonstrates a papillary lesion with atypia or when there is radiologic-pathologic discordance. Otherwise, these lesions can be followed conservatively. Furthermore, for improved diagnostic accuracy, indeterminate intraductal lesions should undergo biopsy with CNB or stereotactic vacuum assisted biopsy and not fine needle aspiration. The cytologic diagnosis of papillary lesions is considered only preliminary by fine needle aspiration, and should await surgical resection and histologic examination to further classify these lesions.

UR - http://www.scopus.com/inward/record.url?scp=33644795185&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33644795185&partnerID=8YFLogxK

U2 - 10.1097/01.jwi.0000200319.22842.2e

DO - 10.1097/01.jwi.0000200319.22842.2e

M3 - Article

AN - SCOPUS:33644795185

VL - 7

SP - 157

EP - 162

JO - Journal of Women's Imaging

JF - Journal of Women's Imaging

SN - 1084-824X

IS - 4

ER -