Open AccessBenign Papillomas of the Breast Diagnosed on Large‐Gauge Vacuum Biopsy compared with 14 Gauge Core Needle Biopsy – Do they require surgical excision?
Author(s) -
Seely Jean M.,
Verma Raman,
Kielar Ania,
Smyth Karl R.,
Hack Kalesha,
Taljaard Monica,
Gravel Denis,
Ellison Erin
Publication year - 2016
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/tbj.12702
Subject(s) - medicine , atypia , biopsy , malignancy , radiology , breast biopsy , papilloma , percutaneous , percutaneous biopsy , breast cancer , surgery , cancer , mammography , pathology
To evaluate whether biopsy with vacuum‐assisted biopsy ( VAB ) devices improves histologic underestimation rates of benign papillomas when compared to smaller bore core needle biopsy ( CNB ) devices. Patients with biopsy‐proven benign papillomas with surgical resection or minimum 12 months follow‐up were selected. Two breast pathologists reviewed all pathology slides of percutaneous and excisional biopsy specimens. Histologic underestimation rates for lesions biopsied with 10–12 Gauge (G) VAB were compared to those with 14G CNB . A total of 107 benign papillomas in 107 patients from two centers were included. There were 60 patients (mean age 57 years, SD 10.3 years) diagnosed with VAB and 47 patients (mean age 57.6 years, SD 11.3 years) with 14G CNB who underwent surgical excision or imaging follow‐up. The upgrade rate to ductal carcinoma in situ or invasive carcinoma was 1.6% (1/60) with VAB and 8.5% (4/47) with 14G. Upgrade to atypia was 3.3% (2/60) after VAB and 10.6% (5/47) with CNB . The total underestimation rates were 5% (3/60) with VAB and 19.1% (9/47) with CNB . The odds of an upgrade to malignancy was 5.5 times higher with a 14G needle than VAB (95% CI : 0.592–50.853, p = 0.17). We observed a lower but not statistically significant upgrade rate to malignancy and atypia with the use of the 10–12 G VAB as compared with 14G CNB . When a papilloma without atypia is diagnosed with vacuum biopsy there is a high likelihood that it is benign; however, if surgical excision is not performed, long‐term follow‐up is still required.