Papillary Breast Lesions on Core Biopsy
Papillary Breast Lesions on Core Biopsy
Evaluation of papillary lesions of the breast can be difficult, and in core needle biopsy specimens, accurate diagnosis is challenging. Initial studies suggested that all papillary lesions revealed by core biopsy required surgical excision. Recent data suggest that only papillary lesions with atypical ductal hyperplasia (ADH) revealed by core biopsy need surgical excision. We evaluated our experience at the University of Washington Medical Center, Seattle, with papillary lesions with and without ADH on core biopsy to determine whether diagnostic accuracy can be achieved. In 51 core biopsy specimens, we evaluated the presence or absence of ADH: 25 were benign papillomas; 26 were papillomas with ADH. Surgical follow-up was available for 36 cases (11 papillomas and 25 papillomas with ADH). Clinical (radiologic) follow-up was available in 5 papilloma cases (average follow-up, 35.6 months). Follow-up revealed that all papillomas on core biopsy were benign. Excisional biopsy revealed ductal carcinoma in situ or invasive carcinoma in 12 (48%) of 25 papillary lesions with ADH. Benign papillomas can be adequately diagnosed with core biopsy. All papillary lesions with ADH require surgical excision owing to the high rate of associated neoplasia.
The spectrum of papillary lesions of the breast includes benign papilloma, papilloma with atypical ductal hyperplasia (ADH), papillary carcinoma in situ, and invasive papillary carcinoma. The evaluation of papillary lesions of the breast can be difficult on surgical excision specimens, with the distinction between a papilloma with ADH and papillary carcinoma in situ frequently being problematic.
With the advent of core needle biopsy, accurate diagnosis of benign papillary lesions vs papillary lesions with ADH or worse has been challenging. Some initial data suggested that all papillary lesions seen on core biopsy required follow-up surgical excision to exclude in situ or invasive carcinoma. This idea is supported by the fact that radiologic imaging, while helpful, cannot reliably distinguish between benign and potentially malignant papillary lesions revealed by core biopsy. More recent data have suggested that benign papillary lesions can be diagnosed comfortably by using core biopsy (particularly on larger core samples), and only papillary lesions with ADH revealed by core biopsy need surgical excision.
Because this area remains controversial, the purpose of the present study was to evaluate our experience at the University of Washington Medical Center (UWMC), Seattle, with papillary lesions revealed by core biopsy to determine whether diagnostic accuracy can be achieved by using core biopsy alone.
Evaluation of papillary lesions of the breast can be difficult, and in core needle biopsy specimens, accurate diagnosis is challenging. Initial studies suggested that all papillary lesions revealed by core biopsy required surgical excision. Recent data suggest that only papillary lesions with atypical ductal hyperplasia (ADH) revealed by core biopsy need surgical excision. We evaluated our experience at the University of Washington Medical Center, Seattle, with papillary lesions with and without ADH on core biopsy to determine whether diagnostic accuracy can be achieved. In 51 core biopsy specimens, we evaluated the presence or absence of ADH: 25 were benign papillomas; 26 were papillomas with ADH. Surgical follow-up was available for 36 cases (11 papillomas and 25 papillomas with ADH). Clinical (radiologic) follow-up was available in 5 papilloma cases (average follow-up, 35.6 months). Follow-up revealed that all papillomas on core biopsy were benign. Excisional biopsy revealed ductal carcinoma in situ or invasive carcinoma in 12 (48%) of 25 papillary lesions with ADH. Benign papillomas can be adequately diagnosed with core biopsy. All papillary lesions with ADH require surgical excision owing to the high rate of associated neoplasia.
The spectrum of papillary lesions of the breast includes benign papilloma, papilloma with atypical ductal hyperplasia (ADH), papillary carcinoma in situ, and invasive papillary carcinoma. The evaluation of papillary lesions of the breast can be difficult on surgical excision specimens, with the distinction between a papilloma with ADH and papillary carcinoma in situ frequently being problematic.
With the advent of core needle biopsy, accurate diagnosis of benign papillary lesions vs papillary lesions with ADH or worse has been challenging. Some initial data suggested that all papillary lesions seen on core biopsy required follow-up surgical excision to exclude in situ or invasive carcinoma. This idea is supported by the fact that radiologic imaging, while helpful, cannot reliably distinguish between benign and potentially malignant papillary lesions revealed by core biopsy. More recent data have suggested that benign papillary lesions can be diagnosed comfortably by using core biopsy (particularly on larger core samples), and only papillary lesions with ADH revealed by core biopsy need surgical excision.
Because this area remains controversial, the purpose of the present study was to evaluate our experience at the University of Washington Medical Center (UWMC), Seattle, with papillary lesions revealed by core biopsy to determine whether diagnostic accuracy can be achieved by using core biopsy alone.
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