Incidence of an Anatomically Separate Carcinoma of the Breast in Patients Diagnosed with a Papillary Lesion on Breast Core Biopsy
Monica Chung, Nella Shapiro, Tova Koenigsberg, Susan Fineberg. Montefiore Medical Center, Bronx, NY
Background: The need for surgical excision in patients diagnosed with a papillary lesion on breast core biopsy is controversial. The concern is that one may miss an associated cancer at the same site which may not be evident on the core biopsy. In our practice, however, we further noted a high incidence of an anatomically separate breast carcinoma (BCa) in patients diagnosed with a papillary lesion on breast core biopsy. We report this incidence.
Design: The pathology database of The Medical Center was searched for all breast core biopsies from 2008 through 2010. All cases with a core biopsy diagnosis of a papillary lesion were included. In all cases other pathologic diagnosis were reviewed and if a diagnosis of BCa was also found it was then determined if it was anatomically separate from the papillary lesion, defined as within a different quadrant of the ipsilateral breast or occurring in the contralateral breast. We also recorded whether the BCa occurred prior to, concurrent with, or after the diagnosis of the papillary lesion. As a comparison group we recorded a similiar number of cases with a BCa diagnosis (either invasive cancer or DCIS) on breast core biopsy during 2008 to 2010 to determine the incidence of an anatomically separate second cancer in this known high risk group.
Results: Between 2008 and 2010 there were 125 papillary lesions diagnosed on breast core biopsy. In 25 of these 125 cases there was an anatomically separate BCa for an incidence of 20%. Of note in 23 of these 25 cases the core biopsy showing a papillary lesion contained a papilloma and 2 showed denovo papillary cancer. The anatomically separate Bca was contralateral in 20 cases, ipsilateral in 4 cases and bilateral in one case. The cancer occured prior to the papillary diagnosis in 11 cases, concurrently in 11 cases and afterward in 3 cases. In the control group of 125 patients with a breast core biopsy diagnosis of Bca over the same time period there were only 12 anatomically second separate breast cancers diagnosed for an incidence of 10%.
Conclusions: A diagnosis of a papillary lesion on breast core biopsy was associated with a 20% incidence of an anatomically separate breast cancer and the majority of these cancers were in the contralateral breast. Our results suggest that some patients with a papillary lesion on breast core biopsy may benefit from high risk imaging surveillance and clinical screening. Additional study is warranted to define this group.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 13, Tuesday Morning