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Sonographically-guided 14-gauge core needle biopsy for papillary lesions of the breast.

Ko ES, Cho N, Cha JH, Park JS, Kim SM, Moon WK - Korean J Radiol (2007 May-Jun)

Bottom Line: The histologic findings upon core biopsy were compared with the surgical, imaging and follow-up findings.An immediate surgical biopsy was recommended for this lesion because of the imaging-histologic discordance.No additional carcinoma was found during the imaging follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.

ABSTRACT

Objective: We wanted to assess the need for surgical excising papillary lesions of the breast that were diagnosed upon sonographically guided 14-gauge core needle biopsy.

Materials and methods: Sixty-nine women (age range: 25-74 years, mean age: 51.7 years) with 69 papillary lesions (4.9%) were diagnosed and followed after performing sonographically guided 14-gauge core needle biopsies. Surgical excision was performed for 44 (64%) of 69 papillary lesions, and 25 lesions were followed with imaging studies (range: 6-46 months, mean: 17.9 months). The histologic findings upon core biopsy were compared with the surgical, imaging and follow-up findings.

Results: Core needle biopsies of 69 lesions yielded tissue that was classified as benign for 43 lesions, atypical for 18 lesions and malignant for eight lesions. Of the 43 lesions that yielded benign papilloma upon core needle biopsy, one had intraductal papillary carcinoma found upon surgery. An immediate surgical biopsy was recommended for this lesion because of the imaging-histologic discordance. No additional carcinoma was found during the imaging follow-up. Surgical excision was performed for 17 atypical papillary lesions, and this revealed intraductal (n = 6) or invasive (n = 2) papillary carcinoma in 8 (47%) lesions. Of the seven intraductal papillary carcinomas, surgery revealed invasive papillary carcinoma in one (14%).

Conclusion: Our results suggest that papillary lesions of the breast that are diagnosed as benign upon sonographically guided 14-gauge core needle biopsy can be followed when the results are concordant with the imaging findings.

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Related in: MedlinePlus

An asymptomatic 52-year-old woman with benign papilloma upon core needle biopsy.A. Collimated photograph of the mediolateral oblique mammogram reveals no focal abnormality in the left subareolar area.B. Sonogram reveals a 7 mm oval mass (arrow) in the left subareolar area. This finding was thought to be concordant with the benign histology of the core biopsy. A subsequent surgical rebiopsy due to the patient's concern also revealed benign papilloma.
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Figure 1: An asymptomatic 52-year-old woman with benign papilloma upon core needle biopsy.A. Collimated photograph of the mediolateral oblique mammogram reveals no focal abnormality in the left subareolar area.B. Sonogram reveals a 7 mm oval mass (arrow) in the left subareolar area. This finding was thought to be concordant with the benign histology of the core biopsy. A subsequent surgical rebiopsy due to the patient's concern also revealed benign papilloma.

Mentions: The pathology results were prospectively compared with the relevant imaging findings to determine concordance or discordance of the biopsy results. Decisions were made by two radiologists working in consensus. Benign pathology was considered concordant if no imaging features that were highly suspicious for malignancy were present, accurate targeting of the needle was shown, adequate samples were obtained and the pathology results suggested a process known to manifest as a mass (7, 8). The findings were discordant when a BI-RADS category of 5 (highly suggestive of malignancy) was given to the lesion at imaging and the corresponding histologic finding was benign. If a lesion's imaging was determined to be concordant with benign pathology, then 6, 12 or 24 months of follow-up was recommended (Fig. 1). All the pathology results that revealed atypia, intraductal or invasive carcinoma received recommendations for surgical excision. Those benign lesions for which an operation was requested by the pathologist and radiologist, due to imaging-pathologic discordance, were also excised.


Sonographically-guided 14-gauge core needle biopsy for papillary lesions of the breast.

Ko ES, Cho N, Cha JH, Park JS, Kim SM, Moon WK - Korean J Radiol (2007 May-Jun)

An asymptomatic 52-year-old woman with benign papilloma upon core needle biopsy.A. Collimated photograph of the mediolateral oblique mammogram reveals no focal abnormality in the left subareolar area.B. Sonogram reveals a 7 mm oval mass (arrow) in the left subareolar area. This finding was thought to be concordant with the benign histology of the core biopsy. A subsequent surgical rebiopsy due to the patient's concern also revealed benign papilloma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627411&req=5

Figure 1: An asymptomatic 52-year-old woman with benign papilloma upon core needle biopsy.A. Collimated photograph of the mediolateral oblique mammogram reveals no focal abnormality in the left subareolar area.B. Sonogram reveals a 7 mm oval mass (arrow) in the left subareolar area. This finding was thought to be concordant with the benign histology of the core biopsy. A subsequent surgical rebiopsy due to the patient's concern also revealed benign papilloma.
Mentions: The pathology results were prospectively compared with the relevant imaging findings to determine concordance or discordance of the biopsy results. Decisions were made by two radiologists working in consensus. Benign pathology was considered concordant if no imaging features that were highly suspicious for malignancy were present, accurate targeting of the needle was shown, adequate samples were obtained and the pathology results suggested a process known to manifest as a mass (7, 8). The findings were discordant when a BI-RADS category of 5 (highly suggestive of malignancy) was given to the lesion at imaging and the corresponding histologic finding was benign. If a lesion's imaging was determined to be concordant with benign pathology, then 6, 12 or 24 months of follow-up was recommended (Fig. 1). All the pathology results that revealed atypia, intraductal or invasive carcinoma received recommendations for surgical excision. Those benign lesions for which an operation was requested by the pathologist and radiologist, due to imaging-pathologic discordance, were also excised.

Bottom Line: The histologic findings upon core biopsy were compared with the surgical, imaging and follow-up findings.An immediate surgical biopsy was recommended for this lesion because of the imaging-histologic discordance.No additional carcinoma was found during the imaging follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.

ABSTRACT

Objective: We wanted to assess the need for surgical excising papillary lesions of the breast that were diagnosed upon sonographically guided 14-gauge core needle biopsy.

Materials and methods: Sixty-nine women (age range: 25-74 years, mean age: 51.7 years) with 69 papillary lesions (4.9%) were diagnosed and followed after performing sonographically guided 14-gauge core needle biopsies. Surgical excision was performed for 44 (64%) of 69 papillary lesions, and 25 lesions were followed with imaging studies (range: 6-46 months, mean: 17.9 months). The histologic findings upon core biopsy were compared with the surgical, imaging and follow-up findings.

Results: Core needle biopsies of 69 lesions yielded tissue that was classified as benign for 43 lesions, atypical for 18 lesions and malignant for eight lesions. Of the 43 lesions that yielded benign papilloma upon core needle biopsy, one had intraductal papillary carcinoma found upon surgery. An immediate surgical biopsy was recommended for this lesion because of the imaging-histologic discordance. No additional carcinoma was found during the imaging follow-up. Surgical excision was performed for 17 atypical papillary lesions, and this revealed intraductal (n = 6) or invasive (n = 2) papillary carcinoma in 8 (47%) lesions. Of the seven intraductal papillary carcinomas, surgery revealed invasive papillary carcinoma in one (14%).

Conclusion: Our results suggest that papillary lesions of the breast that are diagnosed as benign upon sonographically guided 14-gauge core needle biopsy can be followed when the results are concordant with the imaging findings.

Show MeSH
Related in: MedlinePlus