scholarly journals Papillary lesions of the breast: a review

2020 ◽  
Author(s):  
Denny Lara Nuñez ◽  
Fernando Candanedo González ◽  
Mónica Chapa Ibargüengoitia ◽  
Rosaura Eugenia Fuentes Corona ◽  
Antonio Carlos Hernández Villegas ◽  
...  
Keyword(s):  
Gold Standard ◽  
Needle Biopsy ◽  
Imaging Modality ◽  
Surgical Excision ◽  
Breast Tumors ◽  
Breast Lesions ◽  
Core Needle ◽  
Lesion Core ◽  
Papillary Lesions ◽  
Solid Lesions

Papillary breast lesions are rare breast tumors that comprise a broad spectrum of diseases. Pathologically they present as mass-like projections attached to the wall of the ducts, supported by fibrovascular stalks lined by epithelial cells. On mammogram they appear as masses that can be associated with microcalcifications. Ultrasound is the most used imaging modality. On ultrasound papillary lesions appear as homogeneous solid lesions or complex intracystic lesions. A nonparallel orientation, an echogenic halo or posterior acoustic enhancement associated with microcalcifications are highly suggestive of malignancy. MRI has proven to be useful to establish the extent of the lesion. Core needle biopsy is the gold standard for diagnosis. Surgical excision is usually recommended, although treatment for papillomas without atypia is still controversial.

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.

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.

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

Percutaneous Imaging-Guided versus Open Musculoskeletal Biopsy: Concepts and Controversies

2020 ◽  
Vol 24 (06) ◽  
pp. 667-675
Author(s):  
Violeta Vasilevska Nikodinovska ◽  
Slavcho Ivanoski ◽  
Milan Samardziski ◽  
Vesna Janevska
Keyword(s):  
Soft Tissue ◽  
Complication Rate ◽  
Core Needle Biopsy ◽  
Multidisciplinary Team ◽  
Gold Standard ◽  
Needle Biopsy ◽  
Soft Tissue Tumors ◽  
Open Biopsy ◽  
Core Needle ◽  
Similar Accuracy

AbstractBone and soft tissue tumors are a largely heterogeneous group of tumors. Biopsy of musculoskeletal (MSK) tumors is sometimes a challenging procedure. Although the open biopsy is still considered the gold standard for the biopsy of MSK lesions, core needle biopsy can replace it in most cases, with similar accuracy and a low complication rate. The biopsy should be performed in a tertiary sarcoma center where the multidisciplinary team consists of at minimum a tumor surgeon, an MSK pathologist, and an MSK radiologist who can assess all steps of the procedure. Several factors can influence the success of the biopsy including the lesion characteristics, the equipment, and the method used for the procedure. This review highlights some of the important aspects regarding the biopsy of the MSK tumors, with special attention to imaging a guided core needle biopsy and highlighting some of the recent advancements and controversies in the field.

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