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Underestimation of the Presence of Breast Carcinoma in Papillary Lesions Initially Diagnosed at Core-Needle Biopsy¹

¹ From the Department of Radiology, Medical College of Virginia, Box 980615, Richmond, VA 23298-0615. From the 2003 RSNA Annual Meeting. Received December 4, 2003; revision requested February 12, 2004; final revision received March 14, 2006; accepted March 22; final version accepted April 17. Supported by the Blanton-Sweeney Research Endowment MCV Foundation. Address correspondence to M.K.S. (e-mail: mksydnor{at}vcu.edu).

Purpose: To retrospectively determine the degree of underestimation of breast carcinoma diagnosis in papillary lesions initially diagnosed at core-needle biopsy.

Materials and Methods: Institutional review board approval and waiver of informed consent were obtained for this HIPAA-compliant study. Mammographic database review (1994–2003) revealed core biopsy diagnoses of benign papilloma (n = 38), atypical papilloma (n = 15), sclerotic papilloma (n = 6), and micropapilloma (n = 4) in 57 women (mean age, 57 years). Excisional or mammographic follow-up (2 years) findings were available. Patients with in situ or invasive cancer in the same breast or patients without follow-up were excluded. Findings were collected from mammography, ultrasonography, core technique, core biopsy, excision, and subsequent mammography. Reference standard was excisional findings or follow-up mammogram with no change at 2 years. Associations were examined with regression methods.

Results: In 38 of 63 lesions, surgical excision was performed; in 25 additional lesions (considered benign), follow-up mammography (24-month minimum) was performed, with no interval change. In 15 lesions, 14-gauge core needle was used; in 48, vacuum assistance (mean cores per lesion, 8.7). Carcinoma was found at excision in 14 of 38 lesions. Core pathologic findings associated with malignancy were benign papilloma (n = 1), sclerotic papilloma (n = 1), micropapilloma (n = 2), and atypical papilloma (n = 10). Frequency of malignancy was one (3%) of 38 benign papillomas, 10 (67%) of 15 atypical papillomas, two (50%) of four micropapillomas, and one (17%) of six sclerotic papillomas. Excisional findings included lobular carcinoma in situ (n = 2), ductal carcinoma in situ (n = 7), papillary carcinoma (n = 2), and invasive ductal carcinoma (n = 3). Low-risk group (micropapillomas and sclerotic and benign papillomas) was compared with high-risk atypical papilloma group. Core findings were associated with malignancy at excision for atypical papilloma (P = .006). Lesion location, mammographic finding, core number, or needle type were not associated (P > .05) with underestimation of malignancy at excision.

Conclusion: Benign papilloma diagnosed at core biopsy is infrequently (3%) associated with malignancy; mammographic follow-up is reasonable. Because of the high association with malignancy (67%), diagnosis of atypical papilloma at core biopsy should prompt excision for definitive diagnosis.

© RSNA, 2006