Ultrasonography-guided core needle biopsy in differential diagnosis of papillary breast tumors

2009 ◽  
Vol 50 (7) ◽  
pp. 722-729 ◽  
Author(s):  
M. K. Bode ◽  
T. Rissanen ◽  
M. Apaja-Sarkkinen
Keyword(s):  
Core Needle Biopsy ◽  
Predictive Value ◽  
Needle Biopsy ◽  
Malignant Tumors ◽  
Surgical Excision ◽  
Papillary Lesion ◽  
Core Needle ◽  
Final Histology ◽  
Papillary Lesions ◽  
Malignant Lesions

Background: Papillary lesions of the breast are considered diagnostically challenging for various reasons. A relatively high malignancy rate in final pathological analysis has in many cases necessitated excision of these lesions, regardless of core needle biopsy (CNB). Purpose: To assess mammographic, sonographic, and CNB findings of papillary lesions, and to correlate them with final histology obtained by surgical excision. Material and Methods: From 2000–2006, 29 benign and 19 malignant papillary tumors examined with CNB were surgically removed. Mammographic, sonographic, and CNB results were analyzed and correlated with final histology. Results: On ultrasonography (US), 69% (20/29) of the benign lesions were solid and 31% (9/29) were cystic, and 47% of the malignant lesions (9/19) were solid and 53% (10/19) were cystic. The mammographic findings were nonspecific, although most of the malignant tumors (67%, 12/18) were categorized as BI-RADS 4 lesions. The sensitivity, specificity, and positive predictive value of the core needle biopsy histology was 32% (6/19), 100% (29/29), and 100% (6/6), respectively, for papillary carcinoma. A negative predictive value of 91% (21/23) for malignancy and 48% (11/23) for either atypia or malignancy was shown. Of the lesions with CNB diagnosis of benign papillary lesion with atypia, 58% (11/19) turned out to be malignant and 11% (2/19) were benign on surgery. Conclusion: The probability of malignancy is low when the CNB result shows a benign papillary lesion with no atypia. However, the only way to reliably diagnose atypical papillary lesions is to surgically remove all papillary tumors, irrespective of the CNB result. Differentiation between benign and malignant lesions or malignant noninvasive and invasive tumors is not possible based on sonographic or mammographic appearance.

Papillary lesions of the breast: Can larger core needle biopsy samples identify patients who may avoid surgical excision?

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 44-44
Author(s):  
Alice P. Chung ◽  
Kelly T. Huynh ◽  
Jaime Shamonki ◽  
Myung-Shin Sim ◽  
Camelia Lawrence ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Predictive Value ◽  
Needle Biopsy ◽  
Surgical Excision ◽  
Tissue Samples ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Benign Histology ◽  
Papillary Lesions ◽  
Malignant Lesions

44 Background: Papillary lesions of the breast are frequently diagnosed on core needle biopsy (CNB). The ability to distinguish benign from atypical/malignant papillary lesions is limited by the representative nature of the biopsy method; thus follow-up excision is usually recommended. We aimed to determine if larger CNB samples can more reliably predict the true benign nature of a papillary lesion, thereby sparing certain patients a formal surgical excision. Methods: We reviewed medical records of 53 female patients diagnosed with histologically benign papillary lesions on CNB from 2000 to 2010, who subsequently underwent surgical excision. Pathology slides of the CNB were reviewed to document the benign histologic features of the papilloma, the number of cores sampled and the area of tissue biopsied (mm2). Statistical analysis was performed to identify the characteristics of the CNB that were associated with retention of benign histology on excision. Results: Atypical ductal hyperplasia (ADH) and carcinoma were identified in 6% (3/53) and 8% (4/53) of papillary lesions, respectively, when excised. Clinical and radiographic characteristics did not distinguish the ADH/malignant lesions from benign papillomas. The CNB needle sizes ranged from 9- to 18-gauge (median 14). The number of cores sampled ranged from 3-16 (mean 4.5). Patients with benign excisions had a significantly larger area of tissue sampled by CNB than those found to have ADH/malignant lesions on excision (mean ± SD: 95.6 ± 101.2 vs. 41.7 ± 21.9, respectively, p=0.003). By logistic regression, CNB tissue samples consisting of ≥7 cores, or measuring >96 mm2 in aggregate, had a negative predictive value for ADH/malignancy of 100% (AUC of 0.69 and 0.68, respectively). Conclusions: Although no clinical or radiologic features distinguished benign from pathologically significant papillary lesions, larger sample sizes significantly improved the predictive value of benign histology on CNB. A papilloma sampled by ≥ 7 cores or > 96 mm2 showing benign histology at CNB, retained benign features upon excision. Close surveillance may be a reasonable option for patients whose benign papillomas are generously sampled at the time of CNB.

scholarly journals Atypical papillary lesions after core needle biopsy and subsequent breast carcinoma

2011 ◽  
Vol 5 (2) ◽  
pp. 243-248
Author(s):  
Tuenchit Khamapirad ◽  
Caitlin Andrews ◽  
Jenjeera Prueksadee ◽  
Morton Leonard ◽  
Louisea Bonoan-Deomampo ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Papillary Lesion ◽  
Architectural Distortion ◽  
Core Needle ◽  
Multiple Imaging ◽  
Papillary Lesions ◽  
Benign Papilloma

Abstract Background: Papillary lesions of the breast cause diagnostic problem because papillary structures are found in benign and malignant processes. Core needle biopsy is important to make an initial diagnosis, but it still has potential pitfalls. Comparison between core needle biopsy and excisional biopsy can predict the possibility of malignant change in atypical papillary lesions. Objective: Evaluate the concordance between core needle biopsy and excisional results in atypical papillary lesions of the breast. Materials and methods: The pathology database of University of Texas Medical Branch at Galveston, USA was searched for patients with atypical papillary lesions at core needle biopsy who subsequently underwent surgical excision. Pathology reports from the excisional biopsies was also examined to assign each case to one of three categories, downgrade to benign papilloma, no change (remained atypical papillary lesion), and upgrade to carcinoma. The mammograms and ultrasounds were reviewed for each case. They characterized the lesions according to multiple imaging criteria. Results: Twenty-four patients with atypical papillomas at core biopsy subsequently underwent surgical excision. The lesions were downgraded to benign papilloma in 25%, remained atypical papillary lesion in 33%, and upgraded to carcinoma in 42%. On mammographic presentations (n = 23), masses were in 61%, architectural distortion in 4.3%, mass with calcifications in 9%, mass with architectural distortion and calcifications in 4.3%, calcifications alone in 17.4%, and architectural distortion and calcifications in 4.3%. On ultrasound findings (n = 21), solid masses were in 90%, intracystic masses in 10%, peripheral in locations in 81%, and subareolar in location in 19%. Conclusion: Due to the high upgrade rate of atypical papillary lesions to carcinoma (42%), excision of all atypical papillary lesions with wide excision margin is recommended for cases with pathologic diagnosis of atypical papillary lesion on core-needle biopsy.

scholarly journals Development and Validation of a Simple-to-Use Nomogram for Predicting the Upgrade of Atypical Ductal Hyperplasia on Core Needle Biopsy in Ultrasound-Detected Breast Lesions

2021 ◽  
Vol 10 ◽  
Author(s):  
Yun-Xia Huang ◽  
Ya-Ling Chen ◽  
Shi-Ping Li ◽  
Ju-Ping Shen ◽  
Ke Zuo ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Surgical Excision ◽  
Training Set ◽  
Good Discrimination ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Malignant Lesions ◽  
Validation Set

BackgroundThe rate of carcinoma upgrade for atypical ductal hyperplasia (ADH) diagnosed on core needle biopsy (CNB) is variable on open excision. The purpose of the present study was to develop and validate a simple-to-use nomogram for predicting the upgrade of ADH diagnosed with ultrasound (US)-guided core needle biopsy in patients with US-detected breast lesions.MethodsTwo retrospective sets, the training set (n = 401) and the validation set (n = 186), from Fudan University Shanghai Cancer Center between January 2014 and December 2019 were retrospectively analyzed. Clinicopathological and US features were selected using univariate and multivariable logistic regression, and the significant features were incorporated to build a nomogram model. Model discrimination and calibration were assessed in the training set and validation set.ResultsOf the 587 ADH biopsies, 67.7% (training set: 267/401, 66.6%; validation set: 128/186, 68.8%) were upgraded to cancers. In the multivariable analysis, the risk factors were age [odds ratio (OR) 2.739, 95% confidence interval (CI): 1.525–5.672], mass palpation (OR 3.008, 95% CI: 1.624–5.672), calcifications on US (OR 4.752, 95% CI: 2.569–9.276), ADH extent (OR 3.150, 95% CI: 1.951–5.155), and suspected malignancy (OR 4.162, CI: 2.289–7.980). The model showed good discrimination, with an area under curve (AUC) of 0.783 (95% CI: 0.736–0.831), and good calibration (p = 0.543). The application of the nomogram in the validation set still had good discrimination (AUC = 0.753, 95% CI: 0.666–0.841) and calibration (p = 0.565). Instead of surgical excision of all ADHs, if those categorized with the model to be at low risk for upgrade were surveillanced and the remainder were excised, then 63.7% (37/58) of surgeries of benign lesions could have been avoided and 78.1% (100/128) malignant lesions could be treated in time.ConclusionsThis study developed a simple-to-use nomogram by incorporating clinicopathological and US features with the overarching goal of predicting the probability of upgrade in women with ADH. The nomogram could be expected to decrease unnecessary surgery by nearly two-third and to identify most of the malignant lesions, helping guide clinical decision making with regard to surveillance versus surgical excision of ADH lesions.

Management of Papillary Lesions of the Breast: Can Larger Core Needle Biopsy Samples Identify Patients Who May Avoid Surgical Excision?

2013 ◽  
Vol 20 (13) ◽  
pp. 4137-4144 ◽  
Author(s):  
Jaime Shamonki ◽  
Alice Chung ◽  
Kelly T. Huynh ◽  
Myung S. Sim ◽  
Michelle Kinnaird ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Surgical Excision ◽  
Core Needle ◽  
Papillary Lesions

scholarly journals Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy

2016 ◽  
Vol 19 (4) ◽  
pp. 410 ◽  
Author(s):  
Young Ran Hong ◽  
Byung Joo Song ◽  
Sang Seol Jung ◽  
Bong Joo Kang ◽  
Sung Hun Kim ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Core Needle ◽  
Papillary Lesions

Management of BIRADS 3, 4A, and 4B Lesions Diagnosed as Pure Papilloma by Ultrasound-Guided Core Needle Biopsy: Is Surgical Excision Necessary?

2019 ◽  
Vol 26 (7) ◽  
pp. 909-914 ◽  
Author(s):  
Sean D. Raj ◽  
Jordana Phillips ◽  
Tejas S. Mehta ◽  
Liza M. Quintana ◽  
Michael D. Fishman ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Surgical Excision ◽  
Ultrasound Guided ◽  
Core Needle

scholarly journals The negative predictive value of ultrasound-guided 14-gauge core needle biopsy of breast masses: a validation study of 339 cases

2012 ◽  
Vol 12 (3) ◽  
pp. 488-496 ◽  
Author(s):  
Charlie Zhang ◽  
Darrell R. Lewis ◽  
Paola Nasute ◽  
Malcolm Hayes ◽  
Linda J. Warren ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Validation Study ◽  
Core Needle Biopsy ◽  
Predictive Value ◽  
Needle Biopsy ◽  
Ultrasound Guided ◽  
Breast Masses ◽  
Core Needle

Evaluation of a Soft Tissue Mass in the Extremity or Trunk

2018 ◽  
Author(s):  
Daniel C Thomas ◽  
Dale Han
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Physical Examination ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Malignant Tumors ◽  
Soft Tissue Mass ◽  
Tissue Mass ◽  
Core Needle ◽  
Needle Tract

Soft tissue sarcoma (STS) represents a diverse group of malignant tumors derived from mesenchymal elements. Evaluation of a soft tissue mass of the trunk or extremity starts with a detailed history and physical examination, which will help guide further diagnostic evaluation.  Imaging should then be obtained for an STS, with MRI being the preferred modality for the trunk or extremities. Imaging can assist with diagnosis and delineate the extent of the primary lesion, including the relationship to contiguous structures, for treatment planning and assessing resectability. Pathology diagnosis is most commonly performed via examination of a specimen obtained through image-guided percutaneous core-needle biopsy. This requires multidisciplinary planning between Surgery and Radiology to place the needle within the anticipated definitive surgical incision to allow for en bloc resection of the needle tract. Once the diagnosis of an STS is made, appropriate staging studies should be performed based on the history and physical examination and tumor histology, grade, and size. Clinical and pathology data are used to stage STS patients using the American Joint Committee on Cancer staging system, which incorporates the STS site, size and grade of the primary tumor, and absence or presence of nodal and distant metastatic disease. This review contains 6 figures, 6 tables and 50 references Key words: core-needle biopsy, extremity, histology, imaging, risk factors, soft tissue mass, soft tissue sarcoma, staging evaluation, trunk, tumor grade

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