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Vol. 65, No. 4, 2003
Issue release date: December 2003

Role of Mammography, Ultrasound and Large Core Biopsy in the Diagnostic Evaluation of Papillary Breast Lesions

Puglisi F. · Zuiani C. · Bazzocchi M. · Valent F. · Aprile G. · Pertoldi B. · Minisini A.M. · Cedolini C. · Londero V. · Piga A. · Di Loreto C.
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Abstract

Background: It is well recognized that distinguishing benign from malignant papillary lesions of the breast may pose challenging diagnostic problems. To prospectively evaluate the potential role of mammography, ultrasound and image-guided core biopsy in the diagnosis of papillary lesions of the breast. Methods: 1,442 women consecutively underwent 14-gauge core biopsy and in 51 cases (3.5%) a diagnosis of papillary lesion was formulated. Both radiologists and pathologists independently expressed their degree of suspicion of malignancy (not suspicious, low, moderate, high) on the basis of radiological and core biopsy findings, respectively. Surgical excision of the lesion was used as gold standard and diagnostic agreement was assessed by the kappa statistic. Results: At surgery, 19 of the 49 (38.7%) resected cases had a diagnosis of malignancy. A poor agreement was found between mammography and core biopsy results in the categorization of suspicion of malignancy (k = 0.03). Similar data were obtained between ultrasound and core biopsy (k = 0.07). A poor agreement was also observed between radiological and surgical results (k < 0.20). In contrast, a good agreement was found between core biopsy and surgical samples (k > 0.70). However, 5 (26%) out of the 19 malignant cases at surgery were judged as benign or probably benign on core biopsy. Depending on how the categories of suspicion on core biopsy were set up, the range of sensitivity was 74–89%, whereas specificity ranged from 91 to 97%. Conclusions: Image-guided large core biopsy allows for a correct diagnosis in the majority of papillary lesions. However, its sensitivity is not good enough for surgical excision to be avoided.



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References

  1. Tavassoli FA: Papillary lesions; in Tavassoli FA (ed): Pathology of the Breast. Norwalk, Appleton & Lange, 1992, pp 193–227.
  2. Hoda SA, Rosen PP: Practical consideration in the pathologic diagnosis of needle core biopsies of breast. Am J Clin Pathol 2002;118:101–108.
  3. Philpotts LE, Shaheen NA, Jain KS, Carter D, Lee CH: Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: Clinical importance. Radiology 2000;216:831–837.
  4. Liberman L, Bracero N, Vuolo MA, Dershaw DD, Morris EA, Abramson AF, Rosen PP: Percutaneous large-core biopsy of papillary breast lesions. AJR Am J Roentgenol 1999;172:331–337.
  5. Rosen EL, Bentley RC, Baker JA, Soo MS: Imaging-guided core needle biopsy of papillary lesions of the breast. AJR Am J Roentgenol 2002;179:1185–1192.
  6. Mercado CL, Hamele-Bena D, Singer C, Koenigsberg T, Pile-Spellman E, Higgins H, Smith SJ: Papillary lesions of the breast: Evaluation with stereotactic directional vacuum-assisted biopsy. Radiology 2001;221:650–655.
  7. Bazzocchi M, Berra I, Francescutti GE, Del Frate C, Zuiani C, Puglisi F, Di Loreto C: Papillary lesions of the breast: Imaging and role of core biopsy with 14G needles. Radiol Med 2001;101:424–431.
  8. Han BK, Choe YH, Ko YH, Yang JH, Nam SJ: Benign papillary lesions of the breast: Sonographic-pathologic correlation. J Ultrasound Med 1999;18:217–223.
  9. McCulloch GL, Evans AJ, Yeoman L, Wilson AR, Pinder SE, Ellis IO, Elston CW: Radiological features of papillary carcinoma of the breast. Clin Radiol 1997;52:865–868.
  10. Cardenosa G, Eklund GW: Benign papillary neoplasms of the breast: Mammographic findings. Radiology 1991;181:751–755.
  11. Soo MS, Williford ME, Walsh R, Bentley RC, Kornguth PJ: Papillary carcinoma of the breast: Imaging findings. AJR Am J Roentgenol 1995;164:321–326.
  12. Puglisi F, Pertoldi B, Ramello M, Facecchia I, Zuiani C, Bazzocchi M, Beltrami CA, Di Loreto C: Diagnostic accuracy of perforated compression grid approach for mammographically guided core needle biopsy of breast lesions. Cancer Lett 1999;146:181–188.
  13. Kraus FT, Neubecker RD: The differential diagnosis of papillary tumors of the breast. Cancer 1962;15:444–455.
  14. Svanholm H, Starklint H, Gundersen HJG, Fabricius J, Barlebo H, Olsen S: Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic. APMIS 1989;97:689–698.
  15. Yang WT, Suen M, Metreweli C: Sonographic features of benign papillary neoplasms of the breast: Review of 22 patients. J Ultrasound Med 1997;16:161–168.
  16. Schneider JA: Invasive papillary breast carcinoma: Mammographic and sonographic appearance. Radiology 1989;171:377–379.
  17. Michael CW, Buschmann B: Can true papillary neoplasms of breast and their mimickers be accurately classified by cytology? Cancer 2002;96:92–100.
  18. Gomez-Aracil V, Mayayo E, Azua J, Arraiza A: Papillary neoplasms of the breast: Clues in fine needle aspiration cytology. Cytopathology 2002;13:22–30.
  19. Philpotts LE: Controversies in core-needle breast biopsy. Semin Roentgenol 2001;36:270–283.
  20. Liberman L: Percutaneous image-guided core breast biopsy. Radiol Clin North Am 2002;40:483–500.


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