Lisa Catherine El-Amin MD, Presenter: Nothing to Disclose

Sujata Vijay Ghate MD, Abstract Co-Author: Nothing to Disclose

Jay Alan Baker MD, Abstract Co-Author: Nothing to Disclose

Rex Bentley, Abstract Co-Author: Nothing to Disclose

To determine if core biopsy proven benign papillomas of the breast need to be surgically excised.

Institutional review board approval and waiver of informed consent were obtained for this HIPAA-compliant retrospective study. Mammographic and pathologic database review from January 1994-January 2004 revealed 177 papillary lesions diagnosed by core biopsy in 175 women (mean age 59 years). All lesions had at least 24 months of imaging follow up or surgical correlation (excision or mastectomy). A benign core diagnosis (n=120) included benign papilloma, sclerotic papilloma, and papillomatosis (multiple intraductal papillomas). An additional 50 were atypical, and 7 were malignant (papillary carcinoma or carcinoma in-situ). Details regarding core technique, lesion appearance, pathology results, imaging-histopathologic concordance, and follow-up imaging were recorded. Core and surgical pathology results were correlated.

Seventy-five of 177 (42%) lesions were benign without atypia at core biopsy and unchanged after at least 24 months of imaging follow up (median 60 months, range 24-143). Of the remaining 102 lesions (58%) with surgical correlation, 65 (63%) were benign, 15 (15%) were atypical, and 22 (22%) were malignant. Core diagnosis of these cancers was atypical papillary lesion in 15 and malignant in 7. None of the surgically proven cancers was benign at core biopsy.

In our practice, close imaging follow up rather than excision of core biopsy proven benign papillomas was adequate given careful imaging-histopathologic correlation and excision of all atypical and discordant lesions. Given variability of studies in the literature, individual centers should evaluate their own data and tailor their practice accordingly.

This is the largest single center review of papillary lesions diagnosed at core needle biopsy. Our results suggest that surgical excision of benign papillomas may be avoided in some clinical centers.

El-Amin, L, Ghate, S, Baker, J, Bentley, R, Is Surgical Excision of Core Biopsy Proven Benign Papillomas of the Breast Necessary?.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5002087.html