Diagnosis Of Papillary Lesions Research Articles

The role of vacuum assisted excision in diagnosis of papillary lesions without atypia

The role of vacuum assisted excision in diagnosis of papillary lesions without atypia

Role of MRI in Diagnostic Evaluation of Papillary Lesions of the Breast

Purpose : To evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of papillary lesions of the breast. Materials and methods : Among 45 papillary lesions diagnosed at ultrasonography-guided core biopsy (USCB), 27 benign papillary lesions in 22 patients who underwent breast MRI were reviewed. The excsional biopsy was performed in 1-10 days after MRI was done. In MRI findings, lesions were considered suspicious if they show irregular, rim enhancement, or linear enhancement in morphologic evaluation, or washout enhancement pattern of delayed phase in dynamic enhancement characteristics. Diffusionweighted images were analyzed according to visibility of lesions. MRI findings were correlated with pathologic results at excisional biopsy. Results : At excisional biopsy, two lesions (9%) were diagnosed malignant in 22 benign papillary lesions without atypia by USCB and 4 (80%) were malignant in 5 benign papillary lesions with atypia by USCB. Among 18 lesions detected on MRI, 16 lesions showed suspicious findings on MRI, 11 lesions (69%) were diagnosed as benign and 5 (31%) were malignant. Among 12 lesions detected on diffusion weighted imaging, 10 lesions were diagnosed as benign and 2 were malignant. MRI findings were not significantly correlated with pathologic results at excisional biopsy. Conclusion : MRI findings were not useful to predict malignancy in benign papillary lesions diagnosed at USCB, because MRI findings of these were mostly suspicious (88.9%, 16/18). The benign papillary lesion should be included in the false positive lesion on breast MRI.

Clinicopathologic Features of the Papillary Breast Lesions Diagnosed on Ultrasonography-guided Core Needle Biopsy

은 양성 유두종 일부에서 비정형상피증식증이나 관상피내암이 Purpose: It is well recognized that distinguishing benign papillary lesions from malignant papillary lesions on core needle biopsy may pose difficult diagnostic problems. This study was conducted to define the potential role of ultrasoundguided core biopsy for the diagnosis of papillary lesions of the breast. Methods: Twelve hundred and seventy nine women consecutively underwent 14-gauge core biopsy between January 2004 and December 2006. Of the 1,279 patients, 42 patients (3.2%) had papillary lesions of the breast on core needle biopsy. Of these 42 patients, 35 patients underwent surgical excision or sono-guided vacuum assisted excision. We compared the pathologic results of the excised specimens with the pathologic results on core needle biopsy. Results: Of the 35 patients, 23 patients underwent surgical excision and 12 patients underwent sono-guided vacuum assisted excision. Three patients with intraductal papilloma without atypism on the core needle biopsy were confirmed to have intraductal papilloma accompanied with atypism by the final pathology. All 4 patients with papillomatosis or intraductal papilloma with atypism at core needle biopsy were confirmed to have intraductal papilloma with atypism by the final pathology. There were no patients identified to have breast cancer. Conclusion: Our results revealed the accuracy of core needle biopsy for making the diagnosis of papillary lesions of the breast. Surgical excision may not always be necessary for papillary lesion of the breast that is diagnosed on core needle biopsy. Surgical excision is considered in patients with papillomatosis or papillary lesions with atypism seen on core needle biopsy.

Immunohistochemistry increases the accuracy of diagnosis of benign papillary lesions in breast core needle biopsy specimens

Recent studies have suggested that benign papillary lesions without atypia [benign papilloma (BP)] diagnosed on breast core needle biopsy (CNB) may not require excision. However, most have studied only small numbers of cases and scant data are available on the utility of immunohistochemistry in the categorization of papillary lesions on CNB. In the largest published series of BP identified on CNB, we studied the impact of immunohistochemistry on the accuracy of a CNB diagnosis of BP. Breast CNBs (n = 129) with a diagnosis of papillary lesion were immunostained for calponin, p63 and cytokeratin 5/6. Haematoxylin and eosin and immunostained slides were independently reviewed by four breast pathologists. BP was the final excision diagnosis in 35 cases. With the use of immunohistochemistry, the positive predictive value (PPV) of BP diagnosis by the four individual pathologists increased from 72.7-83.3% (mean 79.2%) to 77.8-87.5% (82.1%), the negative predictive value (NPV) increased from 77.8-98.5% (88.6%) to 100% for all four participants and overall accuracy increased from 78.7-92.6% (84.7%) to 90.7-95.4% (92.8%). No case of invasive carcinoma was diagnosed as BP on CNB by any participant. The frequency of ductal carcinoma in situ following a BP diagnosis on CNB ranged from 2.5% to 4.8% (4%) but was only 0-3% (2.3%) after excluding cases that were radiologically suspicious for malignancy. Immunohistochemistry increases accuracy of BP diagnosis in CNB specimens. Benign papillary lesions diagnosed on CNB do not require excision in the absence of suspicious clinical/radiological findings.

Percutaneous Biopsy of Papillary Lesions of the Breast: Accuracy of Pathologic Diagnosis

Objective: The purpose of this study was to determine the accuracy of the pathologic diagnosis of papillary breast lesions when evaluated by percutaneous biopsy. Materials and Methods: A total of 2307 consecutive breast lesions, diagnosed by percutaneous biopsy, were retrospectively reviewed. Of these, 45 lesions were papillary lesions; 15 of the 45 cases were lost to follow-up or had not had imaging follow-up and were excluded. The remaining 30 papillary lesions constituted the study population. Subsequent surgical excision or imaging follow-up (a minimum of 6 months) was performed and correlated with the initial diagnoses. Results: Of the 30 lesions, 11 intraductal papillomas were diagnosed with stereotactic vacuum assisted biopsy (SVAB). Surgical excision was performed on four lesions (36.4%). Pathologic findings in all four lesions (100%) were benign. Of the 13 papillary lesions diagnosed with ultrasound-guided core needle biopsy, three (23.1%) demonstrated papillomatosis. Subsequent surgical excision was performed on 11 (84.6%) of the 13 papillary lesions, including two of the three papillomatosis. Pathology was benign in all. The two (18.2%) other lesions, initially diagnosed as papillomatosis and benign papilloma, were a fibroadenoma and organizing papillomatosis, respectively, at surgery. The six lesions that were sampled with fine needle aspiration (FNA) demonstrated intraductal papillary lesions, two (33.3%) of which had cytologic atypia. Surgical excision was performed on all six (100%) with benign breast tissue in four (66.7%) including one of the lesions demonstrating atypia. The two (33.3%) other lesions demonstrated high-grade invasive papillary carcinoma with in-situ components. Conclusion: Surgical excision is warranted when a percutaneous breast biopsy demonstrates a papillary lesion with atypia or when there is radiologic-pathologic discordance. Otherwise, these lesions can be followed conservatively. Furthermore, for improved diagnostic accuracy, indeterminate intraductal lesions should undergo biopsy with CNB or stereotactic vacuum assisted biopsy and not fine needle aspiration. The cytologic diagnosis of papillary lesions is considered only preliminary by fine needle aspiration, and should await surgical resection and histologic examination to further classify these lesions.