Histological Evaluation of the Papillary Lesions of the Breast from Needle Biopsy to the Excised Specimen: A Single Institutional Experience
Syed M Gilani, Randy S Tashjian, Paul J Kowalski. St. John Hospital & Medical Center, Detroit, MI
Background: The assessment and categorization of papillary lesions remains one of the most challenging areas in breast pathology. In this review, we evaluated the histological follow up of papillary lesions of the breast starting from the needle core biopsy until the final excision. The main focus of this study was to determine that papillary lesions of the breast warrant strong consideration for excision, regardless whether a benign, atypical, or malignant diagnosis is made on biopsy.
Design: After IRB approval, we reviewed the reports of patients diagnosed as papillary lesion on needle core biopsy from January 2001 to June 2011. A total of 91 cases were diagnosed as “papillary lesion” including benign, atypical and malignant on the needle core biopsy.
Results: A total of 29 cases (females mean age of 54.93 ± 12.5 SD) of breast needle core biopsies with the diagnosis of benign papillary lesion were viewed. Of these 29 cases, 19 (65.5%) cases were diagnosed as a benign on final excision, 3 (10.3%) cases were diagnosed as malignant, and the remaining 7 cases did not proceed to excision. The three malignant cases included two cases of ductal carcinoma ins-situ with micropapillary features and one lobular carcinoma in-situ.
Of these 91 cases, 45 cases were diagnosed as malignant, with 44 cases (97.6%) malignant and 1 case ADH. The diagnosis of atypical papillary lesion was determined in 17 cases: 10 malignant, 5 atypical ductal hyperplasia, and 2 benign on the final excision.
When comparing the combination of all atypical and malignant cases with both needle core biopsy and excisional biopsy (other than those having benign diagnosis) to the initial needle core biopsy findings, the differences were more striking (p=0.019). Of these 62 cases (mean age of 61.98 ± 15.20 SD), only 2 cases were diagnosed benign on final excision. Overall for the 91 cases, 21 (23.1%) were benign and 62 cases (68.1%) were atypical or malignant on the final excision.
Conclusions: We concluded that if benign papillary lesion is present on needle core biopsy then the chances of malignancy are high (10.3%, p-value < 0.0005) on the final excision, therefore we suggest excision of all papillary lesions. Similarly, malignant papillary lesions on needle core biopsy should always be excised due to the likelihood of (98%) malignancy on final excision. Based on our study we suggest removal of any type of papillary lesion diagnosed on needle core biopsy.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 20, Tuesday Morning