[214] Correlation of Papillary Neoplasms Diagnosed on Core Needle Biopsy That Underwent Re-Excision at Danbury Hospital between 2009-2011

Lauren Lippincott, Ramapriya Vidhun. Danbury Hospital, Danbury, CT

Background: Papillary lesions of the breast consist of a heterogeneous group than span the spectrum of benign, atypical, and malignant (in situ, invasive) entities. Unfortunately, the morphologic spectrum of papillary lesions does not follow a stepwise progression of increasing proliferation and “atypical features” from benign to malignant examples. Interpretation of papillary lesions of the breast remains a challenging task because of the wide morphologic spectrum encountered in the benign, atypical, and malignant subtypes. Data on clinical significance and outcome of papillary lesions, especially those with superimposed atypia or areas similar to ductal carcinoma in situ, are sparse. Correlation with clinical, mammographic, and sonographic findings is crucial in all papillary neoplasms diagnosed on core biopsies. Whether or not all papillary lesions identified on core biopsies should be surgically excised remains a controversial issue.
Design: We performed a retrospective study of breast core needle biopsy specimens with the finding of papillary neoplasm that underwent subsequent excisional biopsy at Danbury Hospital during a three year period (2009-2011), with the data retrieved from the Cerner databases.
Results: 85 core needle biopsies performed during this period yielded a diagnosis of papillary neoplasm of which 57 (67%) underwent subsequent re-excision. Of the 57 re-excisions, 33 (58%) yielded a benign diagnosis, 15 (26%) yielded atypia (ADH and FEA) and 9 (16%) yielded invasive or in situ carcinoma. There was residual papilloma identified in 17 (51.5%) of the benign, 6 (40%) of the atypical and 8 (89%) of the malignant cases.

Diagnosis Following Re-excision of Intraductal Papilloma
Total (n=57)Benign (n=33) 58%Atypical (n=15) 26%DCIS/Invasive Carcinoma (n=9) 16%
Residual Papilloma1768
No Residual Papilloma1691

Conclusions: Review of literature shows that papillary neoplasms identified on core biopsies yielded a higher lesion in up to 24% of cases. We found that a number of cases showed a malignant (DCIS/invasive carcinoma in 16%) or atypical (ADH, FEA, papilloma with atypia in 26%) diagnosis on excision specimens (p=0.06). Based on our study, re-excision of intraductal papillomas may be prudent in order to capture lesions that may harbor atypia or carcinoma within or in the surrounding breast tissue of a papillary neoplasm.
Category: Breast

Monday, March 4, 2013 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 29, Monday Morning


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