Skip to main content

Advertisement

SpringerLink
Log in

Benign Papilloma on Core Biopsy Requires Surgical Excision

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

When a papillary lesion is identified on core biopsy of an impalpable breast lesion, standard practice involves excisional biopsy. Recent literature has questioned the need for surgical excision in patients with benign core biopsy and radiological concordance. Our aim was to assess whether surgical excision is required by targeting this concordant group in a large screen-detected population.

Methods

A retrospective review of a prospectively collected database of all benign papillary core biopsies between February 1995 and September 2007 at North Western Breast Screen and Monash Breast Screen in Melbourne, Australia was performed. All patients had surgical excision, enabling correlation between core and final excisional biopsy results on all lesions. All histology reports were reviewed and the radiology was reassessed.

Results

During a 14-year period, 5783 core biopsies were performed from 633,163 screening mammograms. Eighty patients (0.01%) had benign papilloma on core biopsy, no patients had atypia on core biopsy, and all patients had benign radiological features. Of the 80 patients, 15 patients were found to have ductal carcinoma in situ (8) or invasive ductal carcinoma (7) on final pathology, yielding a 19% malignant rate.

Conclusion

Core biopsy showing benign papillary lesion, even where radiology is also suggestive of a benign process, cannot exclude malignancy, and therefore surgical excision is required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Valero V, Buzdar AU, Theriault RL, et al. 16-year mortality from breast cancer in the UK Trial of Early Detection of Breast Cancer. Lancet 1999; 353:1909–14

    Article  Google Scholar 

  2. Barth RJ Jr, Gibson GR, Carney PA, et al. Detection of breast cancer on screening mammography allows patients to be treated with less-toxic therapy. AJR Am J Roentgenol 2005; 184:324–9

    PubMed  Google Scholar 

  3. Liberman L. Clinical management issues in percutaneous core breast biopsy. Radiol Clin North Am 2000; 38:791–807

    Article  PubMed  CAS  Google Scholar 

  4. Tavassoli F. (2003) Intraductal papillary neoplasms. WHO Classification of Tumours Pathology and Genetics of Tumours of the Breast and Female Genital Organs. pp 76–80

  5. Reynolds HE. Core needle biopsy of challenging benign breast conditions: a comprehensive literature review. AJR Am J Roentgenol 2000; 174:1245–50

    PubMed  CAS  Google Scholar 

  6. Jacobs TW, Connolly JL, Schnitt SJ. Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? Am J Surg Pathol 2002; 26:1095–110

    Article  PubMed  Google Scholar 

  7. Mercado CL, Hamele-Bena D, Singer C, et al. Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy. Radiology 2001; 221:650–5

    Article  PubMed  CAS  Google Scholar 

  8. Gendler LS, Feldman SM, Balassanian R, et al. Association of breast cancer with papillary lesions identified at percutaneous image-guided breast biopsy. Am J Surg 2004; 188:365–70

    Article  PubMed  Google Scholar 

  9. Page DL, Salhany KE, Jensen RA, et al. Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer 1996; 78:258–66

    Article  PubMed  CAS  Google Scholar 

  10. Ali-Fehmi R, Carolin K, Wallis T, et al. Clinicopathologic analysis of breast lesions associated with multiple papillomas. Hum Pathol 2003; 34:234–9

    Article  PubMed  CAS  Google Scholar 

  11. Gutman H, Schachter J, Wasserberg N, et al. Are solitary breast papillomas entirely benign? Arch Surg 2003; 138:1330–3

    Article  PubMed  Google Scholar 

  12. Carder PJ, Garvican J, Haigh I, et al. Needle core biopsy can reliably distinguish between benign and malignant papillary lesions of the breast. Histopathology 2005; 46:320–7

    Article  PubMed  CAS  Google Scholar 

  13. Agoff SN, Lawton TJ. Papillary lesions of the breast with and without atypical ductal hyperplasia: can we accurately predict benign behavior from core needle biopsy? Am J Clin Pathol 2004; 122:440–3

    Article  PubMed  Google Scholar 

  14. Renshaw AA, Derhagopian RP, Tizol-Blanco DM, et al. Papillomas and atypical papillomas in breast core needle biopsy specimens: risk of carcinoma in subsequent excision. Am J Clin Pathol 2004; 122:217–21

    Article  PubMed  Google Scholar 

  15. Ivan D, Selinko V, Sahin AA, et al. Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy. Mod Pathol 2004; 17:165–71

    Article  PubMed  Google Scholar 

  16. Rosen EL, Bentley RC, Baker JA, et al. Imaging-guided core needle biopsy of papillary lesions of the breast. AJR Am J Roentgenol 2002; 179:1185–92

    PubMed  Google Scholar 

  17. Valdes EK, Feldman SM, Boolbol SK. Papillary lesions: a review of the literature. Ann Surg Oncol 2007; 14:1009–13

    Article  PubMed  Google Scholar 

  18. Liberman L, Tornos C, Huzjan R, et al. Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR Am J Roentgenol 2006; 186:1328–34

    Article  PubMed  Google Scholar 

  19. Mercado CL, Hamele-Bena D, Oken SM, et al. Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology 2006; 238:801–8

    Article  PubMed  Google Scholar 

  20. Arora N, Hill C, Hoda SA, et al. Clinicopathologic features of papillary lesions on core needle biopsy of the breast predictive of malignancy. Am J Surg 2007; 194:444–9

    Article  PubMed  Google Scholar 

  21. Sydnor MK, Wilson JD, Hijaz TA, et al. Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy. Radiology 2007; 242:58–62

    Article  PubMed  Google Scholar 

  22. Ashkenazi I, Ferrer K, Sekosan M, et al. Papillary lesions of the breast discovered on percutaneous large core and vacuum-assisted biopsies: reliability of clinical and pathological parameters in identifying benign lesions. Am J Surg 2007; 194:183–8

    Article  PubMed  Google Scholar 

  23. 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  Google Scholar 

  24. 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

    Article  PubMed  Google Scholar 

  25. Saddik M, Lai R. CD44s as a surrogate marker for distinguishing intraductal papilloma from papillary carcinoma of the breast. J Clin Pathol 1999;52:862–4

    Article  PubMed  CAS  Google Scholar 

  26. Mann G, Fahey VD, Felappa F, et al. Reliance on hormone receptor assays of surgical specimens may compromise outcome in patients with breast cancer. J Clin Oncol 2005;23:5148–54

    Article  PubMed  Google Scholar 

  27. Tan PH, Aw MY, Yip G, et al. Cytokeratins in papillary lesions of the breast: is there a role in distinguishing intraductal papilloma from papillary ductal carcinoma in situ? Am J Surg Pathol 2005;29:625–32

    Article  PubMed  Google Scholar 

  28. Shah VI, Flowers CI, Douglas-Jones AG, et al. Immunohistochemistry increases the accuracy of diagnosis of benign papillary lesions in breast core needle biopsy specimens. Histopathology 2006;48:683–91

    Article  PubMed  CAS  Google Scholar 

  29. Valdes EK, Tartter PI, Genelus-Dominique E, et al. Significance of papillary lesions at percutaneous breast biopsy. Ann Surg Oncol 2006;13:480–2

    Article  PubMed  Google Scholar 

  30. Plantade R, Gerard F, Hammou JC. [Management of non-malignant papillary lesions diagnosed on percutaneous biopsy]. J Radiol 2006;87:299–305

    Article  PubMed  CAS  Google Scholar 

  31. Puglisi F, Zuiani C, Bazzocchi M, et al. Role of mammography, ultrasound and large core biopsy in the diagnostic evaluation of papillary breast lesions. Oncology 2003;65:311–5

    Article  PubMed  Google Scholar 

  32. Irfan K, Brem RF. Surgical and mammographic follow-up of papillary lesions and atypical lobular hyperplasia diagnosed with stereotactic vacuum-assisted biopsy. Breast J 2002;8:230–3

    Article  PubMed  Google Scholar 

  33. Ioffe O, Berg WA, Silverberg SG. Analysis of papillary lesions diagnosed on core needle biopsy: management implications. Mod Pathol 2000;13:23A (abstract)

    Google Scholar 

  34. Philpotts LE, Shaheen NA, Jain KS, et al. Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology 2000;216:831–7

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Royal Melbourne Hospital, Grattan Street, Parkville, 3050, Australia

    Anita Rohini Skandarajah MBBS, MD, FRACS & Gregory Bruce Mann MBBS, PhD, FRACS

  2. Department of Radiology, Royal Melbourne Hospital, Parkville, 3050, Australia

    Arlene Yuen Larn Mou MBBS, FRANZCR

  3. Department of Pathology, Royal Melbourne Hospital, Parkville, 3050, Australia

    Malcolm Buchanan MBBS, FRCPA

  4. Monash Breast Screen, Monash Medical Centre, Melbourne, Victoria, Australia

    Lee Field MBBS, (Hons), FRANZCR & Jill Evans MBBS, FRANZCR

  5. Monash Breast Screen, Monash Medical Centre and Breast Surgery Unit, Monash Medical Centre, Melbourne, Victoria, Australia

    Stewart Hart MBBS, FRACS

Authors
  1. Anita Rohini Skandarajah MBBS, MD, FRACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lee Field MBBS, (Hons), FRANZCR
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arlene Yuen Larn Mou MBBS, FRANZCR
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Malcolm Buchanan MBBS, FRCPA
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jill Evans MBBS, FRANZCR
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stewart Hart MBBS, FRACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gregory Bruce Mann MBBS, PhD, FRACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anita Rohini Skandarajah MBBS, MD, FRACS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Skandarajah, A.R., Field, L., Yuen Larn Mou, A. et al. Benign Papilloma on Core Biopsy Requires Surgical Excision. Ann Surg Oncol 15, 2272–2277 (2008). https://doi.org/10.1245/s10434-008-9962-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-008-9962-6

Keywords

Search

Navigation