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

Sanghee Park, Abstract Co-Author: Nothing to Disclose

To retrospectively determine the upgrade rate of US detected benign intraductal papilloma initially diagnosed at US-guided core needle biopsy in asymptomatic patients.

From 2007.5-2008.12, US-guided core needle biopsies were performed in 1628 patients. Benign intraductal papilloma was diagnosed in 211 lesions in 202 (12.4 %) patients (mean age, 45 years) after core-needle biopsies. Among those lesions, 65 clinically and mammographically occult, US detected benign intraductal papillomas in 59 patients diagnosed by 14 G gun (n= 55) and 11G (n= 10) vacuum assisted biopsy were included. Sixty-one lesions (93.8 %) were surgically excised regardless of their image findings, and four (6.2%) were followed up more than 12 months. On per-lesion basis, upgrade rate to atypical lesions and malignancy were measured, and Fisher exact test and chi-square test was performed to evaluate whether lesion variables (size, and distance from the nipple and imaging findings) and biopsy needle type affect differences in upgrade rate.

Surgical excision revealed remained intraductal papilloma in 40, fibrocystic change or no residual lesion in 12, atypical papilloma or papilloma with adjacent foci of ADH in 7, and papillary ductal carcinoma in situ (DCIS) in two. Upgrade rate to atypical papilloma or ADH and malignancy was 10.8 % (7/65) and 3.1 % (2/65) at core needle biopsy. Mean lesion size was significantly larger in groups of upgrade to malignancy (1.4cm vs. 0.9cm) (P=.039), and there was no upgrade to malignancy in less than 1cm sized lesions. Age, patients’ symptom, distance from the nipple, lesion category, and biopsy needle type were not significantly associated with underestimation of atypical lesion or malignancy at excision (P > .05).

Benign intraductal papilloma diagnosed at US-guided 14 gauge gun biopsy was upgraded to DCIS in 3.1 %. Lesion size was the only significant factor associated upgrade to malignancy.  

Based on this study, image follow up is reasonable for sonographically detected less than 1cm sized benign intraductal papilloma.

Chang, J, Moon, W, Cho, N, Park, S, Ultrasound (US) Detected Benign Papilloma Diagnosed at Percutaneous Breast Biopsy: Upgrade Rate at Surgical Excision.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8005804.html