Papillary breast lesions diagnosed by core biopsy require complete excision

Area of Science:

• Oncology
• Pathology
• Radiology

Background:

• Management of benign papillary breast lesions without atypia diagnosed by core needle biopsy (CNB) remains controversial.
• Surgical excision is standard for papillary lesions with atypia.
• This study addresses the diagnostic uncertainty of benign papillary lesions.

Purpose of the Study:

• To evaluate the surgical outcomes of nonmalignant papillary breast lesions diagnosed via ultrasound-guided 14-gauge CNB.
• To establish clear management guidelines for these lesions.
• To determine the upgrade rate to malignancy or atypia upon surgical excision.

Main Methods:

• Retrospective review of 268 nonmalignant papillary breast lesions (203 benign, 65 atypical) diagnosed by CNB and surgically excised.
• Analysis of medical records, radiologic, and pathologic reports.
• Comparison of histological upgrade rates based on lesion type and clinical/radiologic variables.

Main Results:

• Histological examination revealed upgrade rates of 15.4% for atypical and 5.9% for benign lesions to malignant.
• Additionally, 20.2% of benign lesions were upgraded to atypical.
• Atypia was significantly associated with malignant upgrade; no clinical or radiologic factors predicted upgrade.

Conclusions:

• Nonmalignant papillary lesions diagnosed by CNB exhibit an unacceptable rate of pathological upgrade post-excision.
• Surgical excision is recommended for all breast papillary lesions for definitive diagnosis.
• This approach ensures accurate diagnosis and appropriate patient management.