Stamatia V. Destounis MD, Presenter: Advisory Board, Konica Minolta Group Advisory Committee, Eastman Kodak Company Advisory Committee, Hologic, Inc (R2 Technology, Inc)

Philip Murphy MD, Abstract Co-Author: Nothing to Disclose

Posy Seifert, Abstract Co-Author: Nothing to Disclose

Patricia Somerville, Abstract Co-Author: Nothing to Disclose

Wende W. Young MD, Abstract Co-Author: Nothing to Disclose

Sarah Hanson, Abstract Co-Author: Nothing to Disclose

To evaluate papillary breast lesions diagnosed at needle core biopsy and outcomes of follow-up imaging and surgical findings.

Retrospective review of 4405 needle core biopsies performed in 2005-06 revealed 184 papillary breast lesions/ 182 patients [papilloma (n=158), papillomatosis (n=9), and atypical papillary lesion (n=17)]. Outcomes of follow-up imaging and underestimation of carcinoma by comparison to surgical excision, as applicable, were determined. Patient demographics, lesion presentation, BIRADS® breast density, palpability, biopsy method, needle gauge, number of specimens, and pathology were recorded. For this study, lesions are being followed for a minimum of one year after biopsy.

An equitable distribution of breast density was seen and 86% of lesions were non-palpable. At biopsy a median 6 (range 1-25) samples per lesion were taken. At this time 59% (n=109) of lesions have had follow-up after biopsy [median 346 days (range 26-1039)]. In this study 152 lesions were not recommended for excision and have no cancers reported to date. 32 lesions in the study cohort proceeded to surgical excision [patient preference (n=2), symptomatic papilloma (n=4), ipsilateral cancer (n=7), papillomatosis (n=2), atypical papillary lesion (n=17)]; 97% (n=31) were recommended for surgery by the Radiologist. The excisions revealed 11 carcinomas [55% (n=6) lesions presented as mass without calcifications and 10 initial needle biopsy diagnoses were atypical papillary lesion and one symptomatic papilloma in a patient with ipsilateral cancer]. In these 11 cancers underestimated at core biopsy, 64% (n=7) were sampled without vacuum assistance using a 14 gauge needle.

Overall, carcinoma was underestimated at needle biopsy in 6% (11/184) of papillary lesions. In cases that underwent excision, 34% (11/32) revealed underestimated carcinoma. At needle biopsy, 91% (10/11) of underestimate lesions were diagnosed as atypia. In this study, vacuum assisted biopsies utilizing larger gauge needles were less likely to result in underestimation.

Clinical experience of papillary lesions diagnosed at breast needle core biopsy with imaging follow-up or surgical excision.

Destounis, S, Murphy, P, Seifert, P, Somerville, P, Young, W, Hanson, S, Underestimation of Papillary Breast Lesions by Core Biopsy: Correlation to Surgical Excision.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5006956.html