open access

Vol 90, No 3 (2019)
ORIGINAL PAPERS Gynecology
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-Zaniewska, Benita Siarkiewicz, Karolina Brzuszkiewicz, Joanna Szpor
DOI: 10.5603/GP.2019.0022
·
Pubmed: 30950000
·
Ginekol Pol 2019;90(3):122-127.

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)

Pages

122-127

Published online

2019-03-29

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

References (34)
  1. Ellis IO. Best Practice No 179: Guidelines for breast needle core biopsy handling and reporting in breast screening assessment. Journal of Clinical Pathology. 2004; 57(9): 897–902.
  2. Dietz JR, Crowe JP, Grundfest S, et al. Directed duct excision by using mammary ductoscopy in patients with pathologic nipple discharge. Surgery. 2002; 132(4): 582–7; discussion 587.
  3. Ganesan S, Karthik G, Joshi M, et al. Ultrasound spectrum in intraductal papillary neoplasms of breast. Br J Radiol. 2006; 79(946): 843–849.
  4. Al Sarakbi W, Worku D, Escobar PF, et al. Breast papillomas: current management with a focus on a new diagnostic and therapeutic modality. Int Semin Surg Oncol. 2006; 3: 1–8.
  5. Haagensen CD, Bodain C, Haagensen DE. Breast carcinoma risk and detection. WB Saunders, Philadelphia 1981: 146.
  6. Oyama T, Koerner FC. Noninvasive papillary proliferations. Semin Diagn Pathol. 2004; 21(1): 32–41.
  7. Brookes MJ, Bourke AG. Radiological appearances of papillary breast lesions. Clin Radiol. 2008; 63(11): 1265–1273.
  8. Eiada R, Chong J, Kulkarni S, et al. Papillary lesions of the breast: MRI, ultrasound, and mammographic appearances. AJR Am J Roentgenol. 2012; 198(2): 264–271.
  9. Cardenosa G, Eklund GW. Benign papillary neoplasms of the breast: mammographic findings. Radiology. 1991; 181(3): 751–755.
  10. Daniel BL, Gardner RW, Birdwell RL, et al. Magnetic resonance imaging of intraductal papilloma of the breast. Magn Reson Imaging. 2003; 21(8): 887–892.
  11. Rasmussen BB, Balslev E, Jarle Christensen Ib, et al. Diagnostic challenges in clinical, radiological and histopathological tests regarding papillomatous lesions of the breast. Breast. 2018; 40: 177–180.
  12. Shiino S, Tsuda H, Yoshida M, et al. Intraductal papillomas on core biopsy can be upgraded to malignancy on subsequent excisional biopsy regardless of the presence of atypical features. Pathol Int. 2015; 65(6): 293–300.
  13. Khan S, Diaz A, Archer KJ, et al. Papillary lesions of the breast: To excise or observe? Breast J. 2018; 24(3): 350–355.
  14. Rageth CJ, O'Flynn EAm, Comstock C, et al. First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 2016; 159(2): 203–213.
  15. Saladin C, Haueisen H, Kampmann G, et al. MIBB Group. Lesions with unclear malignant potential (B3) after minimally invasive breast biopsy: evaluation of vacuum biopsies performed in Switzerland and recommended further management. Acta Radiol. 2016; 57(7): 815–821.
  16. D'Orsi CJ, Sickles EA, Mendelson EB. et al.. ACR BI-RADS Atlas: Breast Imaging Reporting and Data System. 5th ed. American College of Radiology, Reston 2013.
  17. Hoda S, Kaplan R. World Health Organization (WHO) Classification of Breast Tumours, 4th ed. The American Journal of Surgical Pathology. 2013; 37(2): 309–310.
  18. Wen X, Cheng W. Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol. 2013; 20(1): 94–101.
  19. Collins LC, Schnitt SJ. Papillary lesions of the breast: selected diagnostic and management issues. Histopathology. 2008; 52(1): 20–29.
  20. Jacobs TW, Connolly JL, Schnitt SJ. Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? Am J Surg Pathol. 2002; 26(9): 1095–1110.
  21. Shiino S, Tsuda H, Yoshida M, et al. Intraductal papillomas on core biopsy can be upgraded to malignancy on subsequent excisional biopsy regardless of the presence of atypical features. Pathol Int. 2015; 65(6): 293–300.
  22. Agoumi M, Giambattista J, Hayes MM. Practical Considerations in Breast Papillary Lesions: A Review of the Literature. Arch Pathol Lab Med. 2016; 140(8): 770–790.
  23. Han SH, Kim M, Chung YRi, et al. Benign Intraductal Papilloma without Atypia on Core Needle Biopsy Has a Low Rate of Upgrading to Malignancy after Excision. J Breast Cancer. 2018; 21(1): 80–86.
  24. Kiran S, Jeong YJu, Nelson ME, et al. Are we overtreating intraductal papillomas? J Surg Res. 2018; 231: 387–394.
  25. Boufelli G, Giannotti MA, Ruiz CA, et al. Papillomas of the breast: factors associated with underestimation. Eur J Cancer Prev. 2018; 27(4): 310–314.
  26. Am Soc Breast Surg. Consensus guideline on concordance assessment of image-guided breast biopsies and management of borderline or high-risk lesions. 2016, Nov 2 . https://www.breastsurgeons.org/about/statements/PDF_Statements/Concordance_and_High%20RiskLesions.pdf.
  27. Nowecki ZI, Jeziorski A, eds . Chirurgiczne leczenie zmian nowotworowych piersi. In: (eds). Biblioteka chirurga onkologa..Vol 5. Via Medica, Gdańsk 2016: 125.
  28. Mosier AD, Keylock J, Smith DV. Benign papillomas diagnosed on large-gauge vacuum-assisted core needle biopsy which span <1.5 cm do not need surgical excision. Breast J. 2013; 19(6): 611–617.
  29. Chang JM, Han W, Moon WK, et al. Papillary lesions initially diagnosed at ultrasound-guided vacuum-assisted breast biopsy: rate of malignancy based on subsequent surgical excision. Ann Surg Oncol. 2011; 18(9): 2506–2514.
  30. Foley NM, Racz JM, Al-Hilli Z, et al. An International Multicenter Review of the Malignancy Rate of Excised Papillomatous Breast Lesions. Ann Surg Oncol. 2015; 22 Suppl 3: S385–S390.
  31. Rasmussen BB, Balslev E, Jarle Christensen Ib, et al. Diagnostic challenges in clinical, radiological and histopathological tests regarding papillomatous lesions of the breast. Breast. 2018; 40: 177–180.
  32. Rageth CJ, O'Flynn EAM, Pinker K, et al. Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 2018 [Epub ahead of print].
  33. Yu Y, Salisbury E, Gordon-Thomson D, et al. Management of papillary lesions without atypia of the breast diagnosed on needle biopsy. ANZ J Surg. 2018 [Epub ahead of print].
  34. Williams KE, Amin A, Hill J, et al. Radiologic and Pathologic Features Associated With Upgrade of Atypical Ductal Hyperplasia at Surgical Excision. Acad Radiol. 2018 [Epub ahead of print].

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