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Erschienen in: Breast Cancer 2/2014

01.03.2014 | Original Article

Underestimation of papillary breast lesions by core biopsy: correlation to surgical excision

verfasst von: Stamatia Destounis, Posy Seifert, Patricia Somerville, Philip Murphy, Renee Morgan, Andrea Arieno, Wende Logan Young

Erschienen in: Breast Cancer | Ausgabe 2/2014

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Abstract

Background

The purpose of this study was to evaluate papillary lesions of the breast diagnosed at needle core biopsy and the outcomes of follow-up imaging and surgical findings.

Methods

Retrospective review of 13,806 needle core biopsies performed from 2004 to 2010 revealed 352 patients with 368 papillary lesions; 137 of these lesions underwent surgical excision and 215 had a minimum of 2 year imaging follow-up. Outcomes of imaging follow-up and underestimation of carcinoma by comparison to surgical excision, as applicable, were determined. Patient demographics, clinical presentation, BI-RADS® breast density, palpability, biopsy methods, number of specimens, and pathology were recorded. A two-tailed Fisher exact test was used to assess associations between biopsy techniques and the results of surgical excision as well as the association between palpability and the results of surgical excision. SAS® V 9.1.3 was used to perform the calculations.

Results

One hundred and thirty-seven lesions proceeded to surgical excision. A total of 28 lesions were underestimated; 21 of these were underestimated carcinomas. When comparing biopsy devices in the underestimated group, 64 % were biopsied with directional vacuum-assisted devices and 36 % with automated large core devices (p < 0.0706). In total 18 % of the palpable lesions were underestimated, whereas 17 % of the nonpalpable lesions were underestimated (p < 0.6560); this was not a significant difference.

Conclusions

Overall, carcinoma was underestimated at needle biopsy in 6 % (21/368) of papillary lesions diagnosed when compared to surgical excision. In cases that underwent excision, 34 % (47/137) revealed carcinoma; 45 % (21/47) of these were underestimated carcinomas. Lesion palpability and biopsy method did not affect underestimation in this study population.
Literatur
1.
Zurück zum Zitat Rosen EL, Bentley RC, Baker JA, Soo MS. Imaging-guided core needle biopsy of papillary lesions of the breast. AJR. 2002;179:1185–92. PubMedCrossRef Rosen EL, Bentley RC, Baker JA, Soo MS. Imaging-guided core needle biopsy of papillary lesions of the breast. AJR. 2002;179:1185–92. PubMedCrossRef
2.
Zurück zum Zitat Rosen PP, Hoda SD. Breast pathology: diagnosis by needle core biopsy. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2006. Rosen PP, Hoda SD. Breast pathology: diagnosis by needle core biopsy. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2006.
3.
Zurück zum Zitat Tseng HS, Chen YL, Chen ST, Wu YC, Kuo SJ, Chen LS, et al. The management of papillary lesion of the breast by core needle biopsy. EJSO. 2009;35:121–4. CrossRef Tseng HS, Chen YL, Chen ST, Wu YC, Kuo SJ, Chen LS, et al. The management of papillary lesion of the breast by core needle biopsy. EJSO. 2009;35:121–4. CrossRef
4.
Zurück zum Zitat Bernik SF, Troob S, Ying BL, Simpson SA, Axelrod DM, Siegel B, et al. Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up. Am J Surg. 2009;197:473–8. PubMedCrossRef Bernik SF, Troob S, Ying BL, Simpson SA, Axelrod DM, Siegel B, et al. Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up. Am J Surg. 2009;197:473–8. PubMedCrossRef
5.
Zurück zum Zitat Jaffer S, Nagi C, Bleiweiss IJ. Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy. Cancer. 2009;115:2837–43. PubMedCrossRef Jaffer S, Nagi C, Bleiweiss IJ. Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy. Cancer. 2009;115:2837–43. PubMedCrossRef
6.
Zurück zum Zitat Skandarajah AR, Field L, Mou AYL, Buchanan M, Evans J, Hart S, et al. Benign papilloma on core biopsy requires surgical excision. Ann Surg Oncol. 2008;15(8):2272–7. PubMedCrossRef Skandarajah AR, Field L, Mou AYL, Buchanan M, Evans J, Hart S, et al. Benign papilloma on core biopsy requires surgical excision. Ann Surg Oncol. 2008;15(8):2272–7. PubMedCrossRef
7.
Zurück zum Zitat Shin HJ, Kim HH, Kim SM, Yang HR, Sohn JH, Kwon GY, et al. Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy: comparison of sonographic features and biopsy methods. AJR. 2008;190:630–6. PubMedCrossRef Shin HJ, Kim HH, Kim SM, Yang HR, Sohn JH, Kwon GY, et al. Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy: comparison of sonographic features and biopsy methods. AJR. 2008;190:630–6. PubMedCrossRef
8.
Zurück zum Zitat Rizzo M, Lund MJ, Oprea G, Schniederjan M, Wood WC, Mosunjac M. Surgical follow-up and clinical presentation of 142 breast papillary lesions diagnosed by ultrasound-guided core-needle biopsy. Ann Surg Oncol. 2008;15(4):1040–7. PubMedCrossRef Rizzo M, Lund MJ, Oprea G, Schniederjan M, Wood WC, Mosunjac M. Surgical follow-up and clinical presentation of 142 breast papillary lesions diagnosed by ultrasound-guided core-needle biopsy. Ann Surg Oncol. 2008;15(4):1040–7. PubMedCrossRef
9.
Zurück zum Zitat Liberman L, Tornos C, Huzjan R, Bartella L, Morris EA, Dershaw DD. Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR. 2006;186:1328–34. PubMedCrossRef Liberman L, Tornos C, Huzjan R, Bartella L, Morris EA, Dershaw DD. Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR. 2006;186:1328–34. PubMedCrossRef
10.
Zurück zum Zitat Ueng SH, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast: a review. Arch Pathol Lab Med. 2009;133:893–907. PubMed Ueng SH, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast: a review. Arch Pathol Lab Med. 2009;133:893–907. PubMed
11.
Zurück zum Zitat Cheng TY, Chen CM, Lee MY, Lin KJ, Hung CF, Wang PS, et al. Risk factors associated with conversion from nonmalignant to malignant diagnosis after surgical excision of breast papillary lesions. Ann Surg Oncol. 2009;16:3375–9. PubMedCrossRef Cheng TY, Chen CM, Lee MY, Lin KJ, Hung CF, Wang PS, et al. Risk factors associated with conversion from nonmalignant to malignant diagnosis after surgical excision of breast papillary lesions. Ann Surg Oncol. 2009;16:3375–9. PubMedCrossRef
12.
Zurück zum Zitat Mercado CL, Hamele-Bena D, Oken SM, Singer CI, Cangiarella J. Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology. 2006;238:801–8. PubMedCrossRef Mercado CL, Hamele-Bena D, Oken SM, Singer CI, Cangiarella J. Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology. 2006;238:801–8. PubMedCrossRef
13.
Zurück zum Zitat Syndor MK, Wilson JD, Hijaz TA, Massey HD, Shaw de Paredes ES. Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy. Radiology. 2007;242(1):58–62. CrossRef Syndor MK, Wilson JD, Hijaz TA, Massey HD, Shaw de Paredes ES. Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy. Radiology. 2007;242(1):58–62. CrossRef
14.
Zurück zum Zitat Renshaw AA, Derhagopian RP, Tizol-Blanco DM, Gould EW. Papillomas and atypical papillomas in breast core needle biopsy specimens. Am J Clin Pathol. 2004;122(2):217–21. PubMedCrossRef Renshaw AA, Derhagopian RP, Tizol-Blanco DM, Gould EW. Papillomas and atypical papillomas in breast core needle biopsy specimens. Am J Clin Pathol. 2004;122(2):217–21. PubMedCrossRef
15.
Zurück zum Zitat Reynolds HE. Core needle biopsy of challenging benign breast conditions: a comprehensive literature review. AJR. 2000;174:1245–50. PubMedCrossRef Reynolds HE. Core needle biopsy of challenging benign breast conditions: a comprehensive literature review. AJR. 2000;174:1245–50. PubMedCrossRef
16.
Zurück zum Zitat Ahmadiyeh N, Stoleru MA, Raza S, Lester S, Golshan M. Management of intraductal papillomas of the breast: an analysis of 129 cases and their outcome. Ann Surg Oncol. 2009;16:2264–9. PubMedCrossRef Ahmadiyeh N, Stoleru MA, Raza S, Lester S, Golshan M. Management of intraductal papillomas of the breast: an analysis of 129 cases and their outcome. Ann Surg Oncol. 2009;16:2264–9. PubMedCrossRef
17.
Zurück zum Zitat Liberman L, Bracero N, Vuolo M, Dershaw DD, Morris EA, Abramson AF, et al. Percutaneous large-core biopsy of papillary breast lesions. AJR. 1999;172:331–7. PubMedCrossRef Liberman L, Bracero N, Vuolo M, Dershaw DD, Morris EA, Abramson AF, et al. Percutaneous large-core biopsy of papillary breast lesions. AJR. 1999;172:331–7. PubMedCrossRef
18.
Zurück zum Zitat Kim MJ, Kim EK, Kwak JY, Son EJ, Park BW, Kim SI, et al. Nonmalignant papillary lesions of the breast at US-guided directional vacuum-assisted removal: a preliminary report. Eur Radiol. 2008;18(9):1774–83. PubMedCrossRef Kim MJ, Kim EK, Kwak JY, Son EJ, Park BW, Kim SI, et al. Nonmalignant papillary lesions of the breast at US-guided directional vacuum-assisted removal: a preliminary report. Eur Radiol. 2008;18(9):1774–83. PubMedCrossRef
19.
Zurück zum Zitat Arora N, Hill C, Hoda S, Rosenblatt R, Pigalarga R, Tousimis E. Clinicopathologic features of papillary lesions on core needle biopsy of the breast predictive of malignancy. Am J Surg. 2007;194:444–9. PubMedCrossRef Arora N, Hill C, Hoda S, Rosenblatt R, Pigalarga R, Tousimis E. Clinicopathologic features of papillary lesions on core needle biopsy of the breast predictive of malignancy. Am J Surg. 2007;194:444–9. PubMedCrossRef
20.
Zurück zum Zitat Ciatto S, Houssami N, Ambrogetti D, et al. Accuracy and underestimation of malignancy of breast core needle biopsy: the Florence experience of over 4000 consecutive biopsies. Breast Cancer Res Treat. 2007;101(3):291–7. PubMedCrossRef Ciatto S, Houssami N, Ambrogetti D, et al. Accuracy and underestimation of malignancy of breast core needle biopsy: the Florence experience of over 4000 consecutive biopsies. Breast Cancer Res Treat. 2007;101(3):291–7. PubMedCrossRef
21.
Zurück zum Zitat Destounis S, Skolny M, Morgan R, Arieno A, et al. Rates of pathological underestimation for 9 and 12 gauge breast needle core biopsies at surgical excision. Breast Cancer. 2011;18:42–50. PubMedCrossRef Destounis S, Skolny M, Morgan R, Arieno A, et al. Rates of pathological underestimation for 9 and 12 gauge breast needle core biopsies at surgical excision. Breast Cancer. 2011;18:42–50. PubMedCrossRef
22.
Zurück zum Zitat Houssami N, Ciatto S, Ellis E, Ambrogetti D. Underestimation of malignancy of breast core-needle biopsy: concepts and precise overall and category-specific estimates. Cancer. 2007;109:487–95. PubMedCrossRef Houssami N, Ciatto S, Ellis E, Ambrogetti D. Underestimation of malignancy of breast core-needle biopsy: concepts and precise overall and category-specific estimates. Cancer. 2007;109:487–95. PubMedCrossRef
23.
Zurück zum Zitat Philpotts L, Hooley R, Lee C. Comparison of automated versus vacuum-assisted biopsy methods for sonographically guided core biopsy of the breast. AJR. 2003;180(2):347–51. PubMedCrossRef Philpotts L, Hooley R, Lee C. Comparison of automated versus vacuum-assisted biopsy methods for sonographically guided core biopsy of the breast. AJR. 2003;180(2):347–51. PubMedCrossRef
Metadaten
Titel
Underestimation of papillary breast lesions by core biopsy: correlation to surgical excision
verfasst von
Stamatia Destounis
Posy Seifert
Patricia Somerville
Philip Murphy
Renee Morgan
Andrea Arieno
Wende Logan Young
Publikationsdatum
01.03.2014
Verlag
Springer Japan
Erschienen in
Breast Cancer / Ausgabe 2/2014
Print ISSN: 1340-6868
Elektronische ISSN: 1880-4233
DOI
https://doi.org/10.1007/s12282-012-0361-2

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