Needle Core Biopsy Has High Sensitivity for Identifying Breast Papillary Lesions Requiring Surgical Excision: Diagnostic Accuracy in 161 Cases
LJ Elavathil, K Onuma, F Mothafar, N Akhtar-Danesh, K Dhamanaskar, A Lytwyn. McMaster University, Hamilton, ON, Canada
Background: Accuracy of needle core biopsy (CBx) to identify breast papillary lesions (PL) that require surgical excision is controversial. Our objective was to assess accuracy of CBx using 3 thresholds that showed substantial interobserver agreement (kappa 0.72-0.77).
Design: CBx cases with PL were identified from the pathology database. CBx with ADH, DCIS or invasive carcinoma (IC) adjacent to the PL were excluded. At least 2 pathologists independently reviewed each CBx and excision using a diagnostic algorithm and resolved discrepancies by consensus. Pathologists were masked to the excision when reviewing the CBx, and vice versa. Primary outcome was surgical excision with at least ADH (ADH+): papillomas with ADH or DCIS, intraductal papillary carcinoma (IDPC), or IC.
Results: Pathology review identified 164 CBx with PL. There were 151 (92%) excisions, 10 (6%) had clinical follow-up only, and 3 (2%) patients were lost to follow-up. Excisions showed 91 benign papillomas with or without UDH, 7 atypical papillomas, 11 papillomas with DCIS, 17 IDPC, 20 IC, 5 benign breast tissue with no residual lesion.
|CBx Threshold||No.||Test performance for identifying PL with ADH+ on excision|
|False +||False -||Sensitivity||Specificity||PPV||NPV|
|Papilloma >10% UDH||89||36||3*||0.95||0.62||0.60||0.95|
|Papilloma ≥50% UDH||73||21||4**||0.93||0.78||0.71||0.95|
|Papillary lesion ADH+||62||12||6***||0.89||0.87||0.81||0.93|