Scoring system to predict under-evaluation in patients diagnosed with benign papilloma at ultrasound-guided core needle biopsy (CNB).

Abstract

Abstract Abstract #2001 Background: The aim of this study was to determine factors that predict under-evaluation of atypical lesion or malignancy in patients diagnosed with benign papilloma at ultrasound-guided core needle biopsy (CNB), and to develop a prediction algorithm for scoring the possibility of a diagnosis upgrade to atypical lesion or malignancy based on clinical, radiological and pathological factors. Methods: The study enrolled patients diagnosed with benign papilloma at ultrasound-guided CNB who subsequently underwent surgical excision of the lesion. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy. Results: A total of 262 patients with benign papilloma at CNB were identified. Of the 110 patients who underwent subsequent surgical excision, 22 (20%) were diagnosed with atypical papilloma or malignancy. Multivariate analysis revealed that mass or calcification on mammography, size on imaging >15 mm, peripheral location, and a palpable lesion were independent predictors of malignancy. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.868 (95% CI: 0.794-0.941), and the negative predictive value was 100% for a score of 0 or 1 (Of the 110 patients, 58 patients had the score of 0 or 1). Conclusions: A scoring system to predict malignancy in patients diagnosed with benign papilloma at CNB was developed based on four factors: peripheral location, palpable lesion, mass or calcification on mammography, size on imaging. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2001.