Breast Papillary Lesion on Needle Core Biopsy: Is Surgical Excision Necessary?
Lorraine Lopez, Kirsten Woolf, David Hicks, Xi Wang. University of Rochester, Rochester
Background: The upgrade rate for breast papillary lesions in excisional specimens following the core biopsies has been reported as 0 to 25%. The necessity for surgical excision of a papillary lesion is still an ongoing debate.
Design: 48 breast core biopsies with central solitary papillary lesions were identified in departmental file from 2006 to 2011. All were followed up with surgical excisions.
Results: 24/48 of the papillary lesions were diagnosed as intraductal papilloma with or without usual hyperplasia at the time of core biopsy. Whereas, 11 were diagnosed as complex sclerotic papillary lesion, 8 as atypical papilloma without further differentiation into ADH or DCIS, and 6 as papillary carcinoma not specifying invasive versus in situ. Majority of the diagnoses were based on the morphological criteria. Immunostain for myoepithelial markers was used to help the diagnosis only in 5 cases. In the follow up excisions, 19/24 of the intraductal papillomas remained the same, 3/24 with no remaining lesion, one upgraded as with focal atypia and only one with changed diagnosis as malignant adenomyoepithelioma involving papillary lesion. All 11 complex sclerotic papillary lesions remained same in excision. While 7/8 atypical papillomas were downgraded as benign papillomas in excision, 1/8 remained the same. In retro-review, at least 6/8 "atypical papillomas" were virtually papilloma with florid ductal hyperplasia. All papillary carcinomas remained the same as carcinoma in excision.
Conclusions: The upgrade rate of papillary lesions in excision specimen in our series is almost zero, other than the case with malignant adenomyoepitheloma in excision. It indicates that as long as we follow the diagnostic criterial, it is possible to differentiate benign versus malignant papillary lesions morphologically on core biopsy, and a surgical excision is not necessary for every papillary lesions.
Immunostain for myoepithelial markers is useful but not necessary for differentiation of papillary lesions.
The high rate for downgrading in the excisions for atypical papillomas indicates that pathologists are often over cautious for the papillary lesions and turn to over diagnose this kind of lesion.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 17, Tuesday Morning