Jung Min Chang MD, Presenter: Nothing to Disclose

Woo Kyung Moon MD, Abstract Co-Author: Nothing to Disclose

Nariya Cho MD, Abstract Co-Author: Nothing to Disclose

To prospectively determine the upgrade rate at surgery in benign papilloma initially diagnosed at US-guided 14G gun or 11G vacuum assisted (VA) biopsies

From 2007.5-2008.3, US-guided core needle biopsies were performed in 2208 patients. Benign papilloma was diagnosed in 106 lesions in 100 (4.5%) patients (mean age, 44 years) after 14G gun (n=88) and 11G VA (n=18) biopsies. Our study protocol was to recommend surgical excision after needle localization for all patients with diagnosis of benign papilloma at core needle biopsy regardless of imaging findings. On a per-lesion basis, upgrade rate to atypical lesions and malignancy was compared between 14G gun and 11G VA biopsies. Fisher exact test was performed to evaluate whether lesion variables (size, and distance from the nipple and imaging findings) as well as biopsy method affect the upgrade rate.

Until March 2008, surgical excision was performed for 74 benign papillomas (69.8%, 74/106) in 69 patients (mean age, 43 years) diagnosed at 14G gun (n= 61) and 11G VA (n=13) biopsies. Surgical excision revealed fibrocystic change or no residual lesion in nine, intraductal papilloma in 57, atypical papilloma or papilloma with adjacent foci of ADH in six, and papillary ductal carcinoma in situ (DCIS) in two. All upgrade cases were found at 14G gun biopsy, and upgrade rate to atypical papilloma or ADH and malignancy was 9.8% (6/61) and 3.2% (2/61) at 14G gun biopsy and 0% at 11G VA biopsy. No residual lesion was found in 61.5% (8/13) at 11G VA biopsy. Lesion size, distance from the nipple, imaging findings, or needle type were not significantly associated with underestimation of atypical lesion or malignancy at excision (P > .05).

Benign intraductal papilloma diagnosed at US-guided 14G gun biopsy was upgraded to ADH in 9.8% (6/61) and DCIS in 3.2% (2/61). No lesion was upgraded to ADH or malignancy at 11G VA biopsy.

Our preliminary results suggest that surgical excision may not be required for benign intraductal papilloma diagnosed at US-guided 11G VA biopsy. However, the small sample size is the limitation.

Chang, J, Moon, W, Cho, N, Benign Papilloma Initially Diagnosed at Ultrasound-guided Core Needle Biopsy: Comparison of Upgrade Rate at Surgical Excision between 14G Gun and 11G Vacuum Assisted Probe.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6019827.html