Follow-up of breast papillary lesion on core needle biopsy: experience in African-American population.

He Wang,Kevin Clarke,Patricia Tsang,Cyril D’Cruz

doi:10.1186/1746-1596-9-86

He Wang, Kevin Clarke + Show 2 more

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https://doi.org/10.1186/1746-1596-9-86

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Abstract

BackgroundThe optimal course of clinical follow-up after a diagnosis of breast papillary lesion on a core needle biopsy (CNB) remains elusive. In particular, no reports in literature have addressed this question in African-American population. We describe our experience with breast papillary lesions in a primarily African-American population.MethodsA search of our database for breast papillary lesions diagnosed on CNB between September 2002 and September 2012 was conducted. Cases were categorized into benign, atypical, and malignant. CK5/6 and CK903 stains were performed when necessary.ResultsA total of 64 breast papillary lesions were diagnosed on CNB, including 55 (86%) benign papillary lesions, 6 (9%) atypical lesions, and 3 (5%) intraductal papillary carcinomas. Of these 64 patients, 29 patients (25 African-Americans, 3 Hispanics, 1 Asian American) underwent lumpectomy within 6 months after CNB. Pathology of the lumpectomy showed: five of the 25 (20%) benign papillary lesions on needle biopsy were upgraded to intraductal or invasive papillary carcinoma; 2 of the 3 atypical papillary lesion cases on core biopsy were upgraded (67%), one into intraductal papillary carcinoma, the other invasive papillary carcinoma; the only case of malignant papillary lesion on CNB remained as intraductal papillary carcinoma on lumpectomy. The rate of upgrade in lumpectomy/mastectomy was 25%. CK5/6 and CK903 immunostains were performed on all seven core needle biopsies that were later upgraded.ConclusionsIn our predominantly African-American urban population, 25% of benign or atypical papillary lesions diagnosed on CNB was upgraded in the final excisional examination. Early excision of all papillary lesions diagnosed on CNB may be justified in this patient population.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/7950117821177201

Highlights

The optimal course of clinical follow-up after a diagnosis of breast papillary lesion on a core needle biopsy (CNB) remains elusive
Cases with surgical follow-up Of the twenty-nine CNB patients who were managed by surgical excision within six months after CNB diagnosis, 25 were African-American, 3 Hispanic and 1 Asian American
Pathology of the lumpectomy showed: five of the 25 (20%) benign papillary lesions on needle biopsy were upgraded to intraductal or invasive papillary carcinoma; 2 of the 3 atypical papillary lesion cases on core biopsy were upgraded (67%), one into intraductal papillary carcinoma, the other invasive papillary carcinoma; the only case of malignant papillary lesion on core needle biopsy remained as intraductal papillary carcinoma on lumpectomy (Table 2, Figure 1A – F)

Summary

Introduction

The optimal course of clinical follow-up after a diagnosis of breast papillary lesion on a core needle biopsy (CNB) remains elusive. Most institutions recommend surgical excision for atypical and malignant papillary breast lesions diagnosed by ultrasound-guided core needle biopsy (CNB). Both surgical excision and serial radiographic follow-up have been recommended by some authors as appropriate management for benign papillary lesions diagnosed by CNB [1,2,3]. A major argument for Papillary lesions of the breast develop as tufts of epithelium with fibrovascular cores that form branching papillae and protrude into ductal lumen. They may present as single or multiple lesions, broad-based or pedunculated. The reported rates of underestimation in literature vary greatly [7], directly responsible for the lack of consensus for clinical management of nonmalignant papillary breast lesions

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