[Core needle biopsy of papillary breast lesions: impact on patient management]

To evaluate the clinical and radiological presentations of papillary breast lesions and to evaluate the performance of core needle breast biopsy in papillary lesions.

We retrospectively studied 55 papillary breast lesions in 46 patients aged 28 to 87 years diagnosed using core needle biopsy in the period 1994-2005. We reviewed the clinical and radiological presentations of the lesions, the findings at histological study after percutaneous biopsy, and the correlation of these findings with those of the surgical biopsy (44 cases) and/or radiological follow-up (42 cases).

The most common mammographic presentation was circumscribed or ill-defined, single or multiple nodules. Ill-defined lesions were significantly associated with malignancy (p < 0.05). The results of the percutaneous biopsy were: benign papillary lesion (n = 32), papillary lesion with atypia (n = 9), and malignant papillary lesion (n = 14). The diagnostic accuracy of core needle biopsy calculated from the 44 cases with surgical confirmation was: sensitivity 63%, specificity 100%, predictive positive value 100%, predictive negative value 73%, and rate of underestimation 25%. During follow-up, increased lesion size or the appearance of new lesions was seen in four patients.

The diagnosis can be suspected in cases of postmenopausal patients with multiple circumscribed or ill-defined, solid or mixed lesions at ultrasound study. Although the finding of an invasive malignant papillary lesion after percutaneous biopsy enables treatment to be planned, in the remaining situations (benign papillary lesion, with atypia, or carcinoma in situ) underestimation is common and the lesion should be surgically excised. Vacuum-assisted biopsy systems might improve these results.