Sonographically-guided 14-gauge core needle biopsy for papillary lesions of the breast

Abstract

Objective: We wanted to assess the need for surgical excising papillary lesions of the breast that were diagnosed upon sonographically guided 14-gauge core needle biopsy.

Materials and methods: Sixty-nine women (age range: 25-74 years, mean age: 51.7 years) with 69 papillary lesions (4.9%) were diagnosed and followed after performing sonographically guided 14-gauge core needle biopsies. Surgical excision was performed for 44 (64%) of 69 papillary lesions, and 25 lesions were followed with imaging studies (range: 6-46 months, mean: 17.9 months). The histologic findings upon core biopsy were compared with the surgical, imaging and follow-up findings.

Results: Core needle biopsies of 69 lesions yielded tissue that was classified as benign for 43 lesions, atypical for 18 lesions and malignant for eight lesions. Of the 43 lesions that yielded benign papilloma upon core needle biopsy, one had intraductal papillary carcinoma found upon surgery. An immediate surgical biopsy was recommended for this lesion because of the imaging-histologic discordance. No additional carcinoma was found during the imaging follow-up. Surgical excision was performed for 17 atypical papillary lesions, and this revealed intraductal (n = 6) or invasive (n = 2) papillary carcinoma in 8 (47%) lesions. Of the seven intraductal papillary carcinomas, surgery revealed invasive papillary carcinoma in one (14%).

Conclusion: Our results suggest that papillary lesions of the breast that are diagnosed as benign upon sonographically guided 14-gauge core needle biopsy can be followed when the results are concordant with the imaging findings.

Fig. 1

An asymptomatic 52-year-old woman with benign papilloma upon core needle biopsy. A. Collimated photograph of the mediolateral oblique mammogram reveals no focal abnormality in the left subareolar area. B. Sonogram reveals a 7 mm oval mass (arrow) in the left subareolar area. This finding was thought to be concordant with the benign histology of the core biopsy. A subsequent surgical rebiopsy due to the patient's concern also revealed benign papilloma.

Fig. 2

An asymptomatic 34-year-old woman with benign papilloma upon core needle biopsy. A. Collimated photograph of the craniocaudal mammogram reveals a 2 cm area of architectural distortion with central density (arrow) in the right subareolar area. B. Sonogram reveals a 1.6 cm irregular hypoechoic mass (arrow) with a spiculated margin and ductal extension. A subsequent surgical rebiopy was recommended due to the imaging-histologic discordance, and it revealed intraductal papillary carcinoma.