Malignant Papillary Lesions Research Articles

Needle core biopsy can reliably distinguish between benign and malignant papillary lesions of the breast

To review 21 screen-detected papillary lesions in which the core biopsy findings suggested a papillary lesion and to correlate pathological and radiological findings in order to assess the risks of associated malignancy and the need for surgical intervention. The appropriate management of non-malignant papillary breast lesions detected on needle core biopsy (NCB) is currently uncertain. Forty-seven papillary breast lesions with a histological diagnosis of papilloma, papilloma with atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS), multiple papillomas, 'papillomatosis' or papillary carcinoma (invasive or in situ) were identified from records at the Leeds Breast Screening and Assessment Unit. The cases were diagnosed between between May 1995 and May 2002. In 21 cases the previous NCB contained a papillary proliferation which had been categorized as either 'B2', benign, 'B3', of uncertain malignant potential, or 'B4', suspicious of malignancy. All of the 19 'B3' or 'B4' cases and one of the two 'B2' lesions had undergone open surgical biopsy. All cases with a previous 'B4' were malignant on subsequent excision. All excised cases with a previous 'B3' or 'B2' were found benign, although four of the 'B3's derived from papillomata associated with an atypical proliferation amounting to ADH. In three of these four (75%) the papillary proliferation had been associated with epithelial hyperplasia of usual type (HUT) on the core and the radiological features were of a mass lesion detected on incident round screen which had increased in size. Our results confirm the accuracy of NCB in the diagnosis of screen-detected papillary lesions of the breast. Surgical excision may not always be necessary following a 'B3' core biopsy.

Role of Mammography, Ultrasound and Large Core Biopsy in the Diagnostic Evaluation of Papillary Breast Lesions

Background: It is well recognized that distinguishing benign from malignant papillary lesions of the breast may pose challenging diagnostic problems. To prospectively evaluate the potential role of mammography, ultrasound and image-guided core biopsy in the diagnosis of papillary lesions of the breast. Methods: 1,442 women consecutively underwent 14-gauge core biopsy and in 51 cases (3.5%) a diagnosis of papillary lesion was formulated. Both radiologists and pathologists independently expressed their degree of suspicion of malignancy (not suspicious, low, moderate, high) on the basis of radiological and core biopsy findings, respectively. Surgical excision of the lesion was used as gold standard and diagnostic agreement was assessed by the kappa statistic. Results: At surgery, 19 of the 49 (38.7%) resected cases had a diagnosis of malignancy. A poor agreement was found between mammography and core biopsy results in the categorization of suspicion of malignancy (k = 0.03). Similar data were obtained between ultrasound and core biopsy (k = 0.07). A poor agreement was also observed between radiological and surgical results (k < 0.20). In contrast, a good agreement was found between core biopsy and surgical samples (k > 0.70). However, 5 (26%) out of the 19 malignant cases at surgery were judged as benign or probably benign on core biopsy. Depending on how the categories of suspicion on core biopsy were set up, the range of sensitivity was 74–89%, whereas specificity ranged from 91 to 97%. Conclusions: Image-guided large core biopsy allows for a correct diagnosis in the majority of papillary lesions. However, its sensitivity is not good enough for surgical excision to be avoided.

Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy.

To evaluate the use of stereotactic directional vacuum-assisted biopsy (SDVAB) in diagnosing and managing papillary lesions of the breast. The authors retrospectively reviewed the mammographic and histopathologic findings of 26 cases in which papillary lesions were diagnosed at SDVAB. In all cases, subsequent surgical excision (n = 20) or long-term imaging follow-up (n = 6) was performed and correlated with findings at SDVAB. SDVAB of 26 lesions yielded tissue that was classified as benign in 12, atypical in six, and malignant in eight. Of the 12 lesions that were diagnosed as histologically benign at SDVAB, six were surgically excised. Of these six lesions, five yielded benign correlative results. The sixth lesion was thought to be discordant with the imaging findings, and was surgically excised and determined to be malignant. Of the six benign lesions that were not surgically sampled for biopsy, five decreased in size and one was not seen at radiographic follow-up. Of the six lesions diagnosed as atypical at SDVAB that were surgically excised, one was benign and five were atypical. None proved to be malignant. Of the eight lesions diagnosed as malignant at SDVAB, surgical excision demonstrated ductal carcinoma in situ in all eight; two also had foci of invasive carcinoma. Benign and malignant papillary lesions of the breast can be reliably diagnosed at SDVAB when the SDVAB results correlate with the imaging findings. However, the extent of malignant papillary disease may be underestimated at SDVAB; in our study, invasive carcinoma was later discovered in 25% of patients with this diagnosis.

Significance on the Expression of Cyclin, MIB-1 in Benign and Malignant Papillary Lesion of the Breast

Significance on the Expression of Cyclin, MIB-1 in Benign and Malignant Papillary Lesion of the Breast

Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance.

To assess the outcome of papillary lesions, radial scars, or lobular carcinoma in situ (LCIS) diagnosed at stereotactic core-needle biopsy (SCNB). Retrospective review of 1,236 lesions sampled with SCNB yielded 22 papillary lesions, nine radial scars, and five LCIS lesions. Diffuse lesions such as papillomatosis, papillary ductal hyperplasia, papillary ductal carcinoma in situ (DCIS), and atypical lobular hyperplasia were not included. The mammographic findings, associated histologic features, and outcome were assessed for each case. Sixteen papillary lesions were diagnosed as benign at SCNB. Of these, five were benign at excision, and 10 were unremarkable at mammographic follow-up. At excision of an unusual lesion containing a microscopic papillary lesion, DCIS was found. Three of four papillary lesions suspicious at SCNB proved to be papillary carcinomas; the fourth had no residual carcinoma at excision. Eight of nine radial scars were excised, which revealed atypical hyperplasia in four scars but no malignancies. One LCIS lesion was found at excision to contain DCIS. Benign or malignant papillary lesions were accurately diagnosed with SCNB in the majority of cases. Cases diagnosed as suspicious for malignancy or with atypia or unusual associated histologic findings should be excised. No malignancies were found at excision of radial scars diagnosed at SCNB. Surgical removal of these lesions following SCNB may not be routinely necessary. DCIS was found in one lesion diagnosed as LCIS at SCNB, which suggests that removal of these lesions may be prudent.

Diagnostic Problems in Differentiated Carcinomas of the Thyroid

In this review article we consecutively address the following issues: differential diagnosis of follicular adenomas and minimally invasive follicular carcinomas, with a special emphasis on the hyalinizing trabecular tumours; differential diagnosis of benign and malignant papillary lesions; individualization of the variants of papillary carcinoma that carry a guarded prognosis; differential diagnosis of differentiated thyroid carcinomas exhibiting foci of other types of thyroid carcinoma, namely mucoepidermoid and poorly differentiated carcinoma; and, finally, the diagnostic problems raised by the so-called mixed medullary-follicular carcinomas.

Papillary neoplasms of the breast: fine-needle aspiration findings in cystic and solid cases.

Papillary neoplasms of the breast are uncommon; at the time of needle aspiration, the diagnostic yield from such lesions can be initially classified as cystic or solid. We describe the fine-needle aspiration findings in four cystic papillary neoplasms (three intracystic papillary carcinomas and one intracystic papilloma) and three solid masses (two sclerosing ductal lesions and one infiltrating ductal carcinoma with prominent papillary component). The smears were examined with respect to the following features: cellularity, architectural pattern in cell groups, cytologic pleomorphism, degree of cohesiveness, morphology and size of individual cells, anisonucleosis, nuclear-cytoplasmic ratio, irregularity of nuclear contour, chromatin texture, macronucleoli, the presence of bipolar nuclei, apocrine cells, and multinucleated giant cells. A combination of cytologic and clinical characteristics may be helpful in distinguishing benign from malignant papillary lesions.

Benign and malignant papillary lesions of the breast. A cytomorphologic study.

Fine-needle aspiration cytology of benign and malignant papillary lesions of the breast has been infrequently described. To define the cytologic features of benign and malignant papillary breast lesions better, the authors retrospectively reviewed the fine-needle aspiration cytology of five cases of histologically proven intracystic papillary carcinoma (IPC) and six cases of histologically proven papilloma. Clinical information was obtained from the medical records in each case. Intracystic papillary carcinoma tended to present as a larger tumor (average, 5 cm) in older women (average, 65.4 years). Papilloma, however, tended to present as a smaller tumor (average, 1.5 cm) in younger women (average, 43 years). Eighty percent of the IPC cases (4/5) and 50% of the papilloma cases (3/6) yielded highly cellular aspirates with complex vascular papillae and single columnar cells. Macrophages were a constant feature of IPC and were present in all but one case of papilloma. Although cellular atypia was not a prominent feature in either IPC or papilloma, moderate atypia was noted in one case of IPC and two cases of papilloma. Severe atypia was noted in a single case of IPC. Although IPC tended to yield a harvest with higher cellularity and single intact cells, no single feature or constellation of findings was consistently reliable in distinguishing IPC from papilloma. The authors found that papillary lesions of the breast demonstrate a distinct cytomorphology characterized by complex vascular papillae, columnar cells, and macrophages. They concluded, however, that, in the absence of overt cytologic malignancy, distinguishing between benign and malignant papillary breast lesions is difficult, if not impossible.

Expression of intermediate filament proteins in normal and diseased thyroid glands.

A total of 67 samples from normal and pathological thyroid glands were stained (as formalin fixed paraffin sections) with a panel of monoclonal antibodies directed against intermediate filament proteins. The study confirmed previous reports of cytokeratin and vimentin coexpression in primary thyroid carcinomas, but coexpression was also detected in normal thyroid and in a range of benign conditions including follicular adenomas, Hashimoto's thyroiditis, and diffuse hyperplasia (thyrotoxicosis). Prekeratin expression was found (using antibodies recognising higher molecular weight cytokeratins) predominantly in areas of squamous change, independent of the underlying thyroid pathology. This study does not therefore support previous findings that prekeratin expression provides a reliable means of distinguishing follicular pattern papillary carcinoma from follicular carcinoma with its poorer prognosis or that it helps distinguish benign from malignant papillary lesions. No evidence of desmin or neurofilament expression was seen, and in particular, neurofilaments could not be detected in any of the cases of medullary carcinoma studied.

Malignant and benign papillary lesions of the breast

This presentation describes criteria that we found most helpful in classifying the various proliferative changes of the breast and in separating papillary carcinoma from other benign papillary lesions. The criteria we used are easily understood and extremely reproducible. The true incidence of benign proliferative changes in fibrocystic disease and the significance of these lesions in later development of cancer were determined by studying 200 randomly selected cases of fibrocystic disease seen at least 10 years earlier. Of the 200 cases of fibrocystic disease, 40 showed intraductal papillomatosis or terminal duct hyperplasia. None of the patients with benign proliferative lesions for whom we have complete follow-up data (up to 14 years) developed cancer. In order to determine the type of proliferating cells in papillary carcinoma and benign proliferative lesions, some of the recently encountered cases were studied by transmission and scanning electron microscopy and histochemistry. Our ultrastructural and histochemical study suggests that both epithelial and myoepithelial cells participate in papillary lesions of the breast.