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BS05
PAPILLARY LESION ON PERCUTANEOUS BREAST NEEDLE BIOPSY – IS SURGICAL EXCISION NECESSARY?
Author(s) -
Law M. T.,
Bennett I. C.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04913_5.x
Subject(s) - medicine , malignancy , biopsy , radiology , incidence (geometry) , percutaneous , retrospective cohort study , surgery , physics , optics
Purpose: Malignancy is encountered in 15–24% of papillary lesions identified on percutaneous breast needle biopsies (FNA and core). We aim to determine the incidence of malignancy in our clinic and to identify features which may help differentiate benign from malignant lesions, avoiding the need for routine excisional biopsy. Method: Retrospective review of all needle biopsies showing papillary lesions between 2006 and 2007 at the Wesley Breast Clinic. Correlations of Clinico‐radiological features and definitive histology were tested using Chi Square test with clinical significance defined as p < 0.05. Results: 127 biopsies were performed on 102 patients. 47% were screen detected. 100 patients underwent surgery, 2 were managed conservatively. Malignancy rate on definitive histology was 18% with most showing invasive disease (12/18). Atypical or malignant core biopsy findings (p < 0.05), high ultrasound BIRADS score (p = 0.0021), and being post‐menopausal (p < 0.05) were found to be strong predictors of malignancy. Of the 2 conservatively treated patients, no clinico‐radiological changes were identified over a 9–12 months follow‐up period. Conclusion: The incidence of malignancy in our institution is comparable with world literature. Although our series did not identify a low risk group where conservative management is suitable, patients demonstrating strong predictors of malignancy stated above should certainly not be considered for such approach. Use of new techniques such as immunohistochemistry to improve core biopsy accuracy may lead to identification of a true benign group.