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Papillary Lesions of the Breast at Percutaneous Core-Needle Biopsy¹

¹ From the Departments of Radiology (C.L.M., C.I.S.) and Pathology (J.C.), NYU Medical Center, 160 E 34th St, 3rd Floor, New York, NY 10016; and Departments of Pathology (D.H.) and Radiology (S.M.O.), New York Presbyterian Hospital-Columbia University, New York, NY. From the 2003 RSNA Annual Meeting. Received October 26, 2004; revision requested January 3, 2005; revision received February 24; accepted March 17; final version accepted May 17. Address correspondence to C.L.M. (e-mail: cecilia.mercado{at}med.nyu.edu).

Purpose: To retrospectively review the imaging and histologic findings in patients in whom a benign papillary lesion was diagnosed at core-needle breast biopsy.

Materials and Methods: This retrospective study was approved by the institutional review board at each institution; patient consent was not required. The study was HIPAA compliant. The authors reviewed the findings from 42 patients (age range, 26–76 years; mean age, 54.3 years) with 43 benign papillary lesions diagnosed at core-needle biopsy. Thirty-six (84%) of the 43 lesions were surgically excised, and seven (16%) were followed up with long-term imaging. The authors assessed the radiographic findings, the histologic findings at core-needle biopsy, and the findings at subsequent surgical excision or imaging follow-up. Statistical analysis was performed on a per-patient basis and included the Blyth-Still-Casella procedure to construct exact 95% confidence intervals (CIs) and the Fisher exact test.

Results: At core-needle biopsy, lesions were diagnosed as papilloma (n = 29), sclerosing papilloma (n = 8), and benign papillary lesions not otherwise specified (n = 6). For the 36 lesions that were surgically excised, histologic follow-up showed no residual lesion in 10, intraductal papilloma in 14, intraductal papillomatosis in two, papilloma with adjacent foci of atypical ductal hyperplasia (ADH) in eight, and well-differentiated papillary ductal carcinoma in situ (DCIS) in two. Mammographic follow-up in the remaining seven lesions revealed stable calcifications in five (at 28–55 months) and no residual lesion in two (at 26–29 months). In nine of the 42 patients (21%), the diagnosis was upgraded to either ADH or DCIS (exact two-sided 95% CI = 11.4%, 36.4%).

Conclusion: The results strongly suggest that papillary lesions diagnosed as benign at core-needle biopsy should be surgically excised because a substantial number of lesions were upgraded to ADH and DCIS at excision.

© RSNA, 2006

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