Presence of Atypia in Breast Papillary Lesions in Core Biopsy: Does It Matter to the Clinician?
Miral Mashhour, Ahmed Shehata, Lolwah Alriyees, Reda S Saad. Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Background: The presence of atypical or usual epithelial proliferations within papillary breast lesions complicates their interpretation. The distinction between benign and malignant papillary proliferations on core biopsy can be very challenging without formal excision. There is few available data on clinical significance and outcome of papillary lesions, with superimposed atypia (atypical ductal hyperplasia partially replacing the benign elements). The objective of this study is to evaluate the diagnostic implication of atypia in breast papillary lesions diagnosed on core biopsies.
Design: We retrieved core biopsies diagnosed as papillary lesion from the hospital archives during last 8-years period. One hundred and forty two biopsy specimens of papillary breast lesions with their subsequent resections were reviewed. Cases were divided into two groups: Papillary lesions without atypia (73 cases with their subsequent lumpectomies) and papillary lesions with atypia (69 cases with their subsequent lumpectomies). Corresponding excision biopsies were examined in all cases and findings were correlated with core biopsy.
Results: Of the 73 of papillary lesions without atypia, their subsequent surgical resections showed intraductal papilloma (IDP) in 34/73 (47%), fibrocystic changes (FCC) in 30/73 (41%), atypical papillary proliferation in 3/73 (4%), lobular carcinoma in situ (LCIS) in 2/73 (3%), and invasive ductal carcinoma (IDC), ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH), 1/73 (1%) each case. For the papillary lesions with atypia, subsequent resections showed IDC in 6/69 (9%), DCIS in 21/69 (30%), intracystic carcinoma in 2/69 (3%), atypical papillary lesion in 4/69 (6%), ADH in 2/69 (3%), and LCIS in 2/69 (3%). The remaining 32/69 (46%) cases showed FCC. There is a significant correlation between the presence of atypia in papillary lesion and detection of a significant lesion on excisional biopsy (P< 0.001).
Conclusions: Our study showed a significant correlation between presence of atypia in papillary lesions diagnosed on core biopsy and the presence of malignancy in lumpectomy. Therefore, evaluation and reporting of atypia is crucial in core biopsy report of papillary lesions and may be helpful to the clinician for patient management.
Monday, February 28, 2011 1:00 PM
Poster Session II # 35, Monday Afternoon