open access

Vol 90, No 3 (2019)
Research paper
Published online: 2019-03-29
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Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy

Diana Hodorowicz-Zaniewska12, Benita Siarkiewicz1, Karolina Brzuszkiewicz12, Joanna Szpor23
·
Pubmed: 30950000
·
Ginekol Pol 2019;90(3):122-127.
Affiliations
  1. 1st Chair of General Surgery, Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Cracow, Poland
  2. University Center for Breast Diseases, University Hospital in Cracow, Poland
  3. Chair of of Pathomorphology, Jagiellonian University Medical College, Cracow, Poland

open access

Vol 90, No 3 (2019)
ORIGINAL PAPERS Gynecology
Published online: 2019-03-29

Abstract

Objectives: The aims of the study were as follows: 1) to determine the applicability of vacuum-assisted core needle biopsy in the diagnosis and management of intraductal papillomas of the breast; 2) to define factors which increase the risk for underestimation of breast cancer. 

Material and methods: Between 2002–2017, a total of 222 cases of intraductal papillomas were diagnosed in one center (201 using vacuum-assisted core-needle ultrasound-guided biopsy and 21 using stereotactic biopsy). All patients under- went scheduled follow-up imaging. 

Results: Pure papillomas were diagnosed in 158 women, whereas papillomas with atypia, in this case atypical ductal hyperplasia (ADH), were found in 29 subjects. In the latter group, 3 cases of invasive carcinoma and 5 cases of ductal carci- noma in situ (DCIS) were detected using open surgical biopsy. Breast cancer underestimation in that group of patients was 20%. Overall, ADH, whose presence increases the risk for BC by thirteen-fold as compared to other accompanying lesions, proved to be the most important predictive factor. Also, age, non-radical biopsy excision, and high BI-RADS ultrasound and mammogram scores increased the probability of malignancy. During the control follow-up, no cases of IP recurrence in the primary localization were observed in the group without open surgical biopsy. 

Conclusions: Vacuum-assisted core needle biopsy is an efficient tool in the diagnosis and management of intraductal papillomas of the breast. Surgical excision is not indicated in cases when a pure intraductal papilloma, and data correlation between the diagnosis and the clinical presentation were confirmed. Regardless, caution is advised if residual lesions were left and in older populations. Open surgical biopsy should remain the standard of care in cases with atypia and discordance between clinical and pathology data. 

Abstract

Objectives: The aims of the study were as follows: 1) to determine the applicability of vacuum-assisted core needle biopsy in the diagnosis and management of intraductal papillomas of the breast; 2) to define factors which increase the risk for underestimation of breast cancer. 

Material and methods: Between 2002–2017, a total of 222 cases of intraductal papillomas were diagnosed in one center (201 using vacuum-assisted core-needle ultrasound-guided biopsy and 21 using stereotactic biopsy). All patients under- went scheduled follow-up imaging. 

Results: Pure papillomas were diagnosed in 158 women, whereas papillomas with atypia, in this case atypical ductal hyperplasia (ADH), were found in 29 subjects. In the latter group, 3 cases of invasive carcinoma and 5 cases of ductal carci- noma in situ (DCIS) were detected using open surgical biopsy. Breast cancer underestimation in that group of patients was 20%. Overall, ADH, whose presence increases the risk for BC by thirteen-fold as compared to other accompanying lesions, proved to be the most important predictive factor. Also, age, non-radical biopsy excision, and high BI-RADS ultrasound and mammogram scores increased the probability of malignancy. During the control follow-up, no cases of IP recurrence in the primary localization were observed in the group without open surgical biopsy. 

Conclusions: Vacuum-assisted core needle biopsy is an efficient tool in the diagnosis and management of intraductal papillomas of the breast. Surgical excision is not indicated in cases when a pure intraductal papilloma, and data correlation between the diagnosis and the clinical presentation were confirmed. Regardless, caution is advised if residual lesions were left and in older populations. Open surgical biopsy should remain the standard of care in cases with atypia and discordance between clinical and pathology data. 

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Keywords

intraductal papilloma; B3 breast lesions; vacuum-assisted core needle biopsy; breast carcinoma

About this article
Title

Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy

Journal

Ginekologia Polska

Issue

Vol 90, No 3 (2019)

Article type

Research paper

Pages

122-127

Published online

2019-03-29

Page views

1911

Article views/downloads

1617

DOI

10.5603/GP.2019.0022

Pubmed

30950000

Bibliographic record

Ginekol Pol 2019;90(3):122-127.

Keywords

intraductal papilloma
B3 breast lesions
vacuum-assisted core needle biopsy
breast carcinoma

Authors

Diana Hodorowicz-Zaniewska
Benita Siarkiewicz
Karolina Brzuszkiewicz
Joanna Szpor

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