Sadia Choudhery MD, Presenter: Nothing to Disclose

Kinsey Rowe Pillsbury MD, Abstract Co-Author: Nothing to Disclose

Stephen Jacob Seiler MD, Abstract Co-Author: Nothing to Disclose

Sally Goudreau MD, Abstract Co-Author: Nothing to Disclose

Radial scars and papillomas have historically been considered high-risk lesions because of their association with malignancy and have warranted surgical excision after diagnosis with core needle biopsy. There is limited data supporting the need for surgical excision of these lesions when diagnosed with vacuum-assisted biopsy. The aim of our study is to determine if the use of large gauge vacuum-assisted biopsy devices to diagnose radial scar and papilloma accurately confirms benignity of these lesions. Our hypothesis is that the incidence of upgrade to atypia or malignancy is low enough in lesions sampled with a 12 gauge or larger vacuum-assisted needle, versus those biopsied with a 14 gauge spring loaded needle, that subsequent surgical excision is not needed.

A retrospective chart review was performed of all core needle biopsy cases between January 2008 and January 2014 which yielded radial scar and/or papilloma as the highest risk lesion. The needle gauge of the initial biopsy sample,  pathology at surgical excision, and stability at follow up were evaluated.

Out of 86 papillomas without atypia, 77 (90%) were confirmed benign with greater than 2 year follow-up or surgical excision. Seven lesions (8%) were upgraded to atypia and 2 lesions (2%) were upgraded to ductal carcinoma in-situ (DCIS). There were no cases upgraded to invasive disease. Eight (90%) of the lesions that were upgraded to either atypia or DCIS were biopsied with a 14 gauge needle, and the remaining lesion (10%) was biopsied with a 12 gauge needle. Out of 39 radial scars without atypia, 32 (82%) were confirmed benign with greater than 2 year follow-up or surgical excision. Six lesions (15.4%) were upgraded to atypia and 1 lesion (2.6%) was upgraded to DCIS. There were no cases upgraded to invasive disease. Five (71.4%) of the lesions that were upgraded to either atypia or DCIS were biopsied with a 14 gauge needle, and the remaining 2 lesions (28.6%) were biopsied with a 9 gauge and 12 gauge needle.  

The incidence of lesion upgrade to atypia or malignancy is significantly low for papillomas and radial scars diagnosed with a 12 gauge or larger vacuum-assisted core needle biopsy.

The diagnosis of benign papilloma or radial scar obtained with vacuum-assisted core needle biopsy utilizing a 12 gauge or larger needle is accurate and obviates the need for subsequent surgical excision.

Choudhery, S, Pillsbury, K, Seiler, S, Goudreau, S, Core Biopsy Diagnosis of Papilloma and Radial Scar: Do We Follow-up or Excise These High Risk Lesions?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008445.html