Non-Atypical Papillary Lesions of the Breast Diagnosed on Core Biopsy: Follow-Up Surgical Excision of 110 Cases.
Darren T Wheeler, Brian L Strauss. QUEST Diagnostics, Las Vegas, NV
Background: The management of non-atypical papillary lesions of the breast diagnosed on core biopsy remains controversial. Although there is consensus on the recommendation for excision of any papillary lesion showing atypia, there is varied opinion on whether or not papillary lesions can be accurately diagnosed on core biopsy. Our objective was to review the follow-up surgical excision of non-atypical papillary lesions diagnosed by core biopsy and determine how often the lesions were upgraded, and if there were any clinical or histologic features that may be predictive of a false negative core sample.
Design: Core biopsy cases with a papillary lesion were identified from our local pathology database over the 5 year period 2005-2010. Fine needle aspiration cytology specimens and any core biopsy with ADH, DCIS, or invasive carcinoma were excluded. Any case that did not have a surgical excision available was also excluded. Both the core biopsies and surgical excisions were independently reviewed by the two authors.
Results: There were 110 cases which met the above criteria. The papillary lesions ranged in size from 0.2 cm to 2.2 cm (median = 0.7 cm). The papillary lesions were associated with calcifications in 33 (30%) cases. The follow-up surgical excisions revealed non-atypical papillomas in 91 (83%) cases, no residual lesion in 14 (13%) cases, ADH in 3 (3%) cases, and DCIS in 2 (2%) cases, for a negative predictive value (NPV) of 95%. No invasive carcinomas were identified. The cases showing ADH and DCIS ranged in size from 0.5 cm to 2.2 cm (median = 1.7 cm). None of the cases showing ADH or DCIS were associated with calcifications.
Conclusions: Our study shows a false negative rate of 5% for non-atypical papillary lesions diagnosed on core biopsy. In our series, if a size threshold of >1.5 cm was used for recommending excision, the NPV of the core sample could be increased from 95 to 99% and only 3 (3%) non-atypical papillary lesions would have been excised unnecessarily. This study supports the accuracy of the core biopsy in assessing atypia in papillary lesions and suggests the use of a size cutoff in clinical management to decrease the number of unnecessary surgical excisions.
Monday, February 28, 2011 1:00 PM
Poster Session II # 52, Monday Afternoon