Non-Atypical Papillary Lesions on Core Biopsy: Do All of Them Require Surgical Excision? A Meta-Analysis of 604 Cases
D Jaggessarsingh, M Singh, J Liu, P Fisher, C Tornos. Stony Brook University Medical Center, Stony Brook, NY
Background: All papillary breast lesions with atypia on core biopsy are excised because of a high risk of associated malignancy. However there is still controversy regarding the need for excision of all non-atypical lesions. A meta-analysis was performed to estimate the percentage of cases upgraded to DCIS or invasive carcinoma (IC) after immediate surgical excision, and to evaluate possible radiological, and clinical features that may be predictive of malignancy.
Design: Relevant studies were identified using Pub med database. Studies included were those that provided sufficient data to calculate the percentage of cases upgraded, and that excluded the association of other high grade lesions on the biopsy. Parameters recorded included: size and appearance of the lesion on imaging studies, location (central vs. peripheral), needle gauge, number of cores, residual lesion after core Bx (completely excised or not), and whether the papillary lesion was an incidental finding or not.
Results: Twenty three articles were found including 604 cases. Fifty five lesions were upgraded to DCIS or invasive carcinoma (9.1%) in the surgical specimen (30 DCIS, 11 IC, 8 papillary carcinoma, 6 not specified).Eleven studies correlated false negative cases with clinical and radiological features. Two features that some studies reported more commonly in these cases include microcalcifications (MC), and a size ≥ 2 cm. However these features were only evaluated in few studies (MC in 17, size in 5). Needle gauge, complete excision of the lesion by core biopsy, location (central vs. peripheral), number of cores, and whether the papillary lesion was the target lesion or an incidental finding were not evaluated in the majority of studies, although they could be potentially useful in predicting malignancy.
Conclusions: This meta-analysis shows a 9.1% false negative rate for papillary lesions without atypia . The presence of MC within the lesion and a size ≥ 2 cm correlate with an increased risk of malignancy in some studies. However most studies fail to analyze these and other parameters that may aid in predicting malignancy. We recommend including them in any future studies.
Monday, March 22, 2010 8:15 AM
Platform Session: Section C, Monday Morning