Accuracy of percutaneous core needle biopsy in diagnosing papillary breast lesions and potential impact of sonographic features on their management.

OBJECTIVE

To assess retrospectively the accuracy of core needle biopsy in diagnosing papillary breast lesions and evaluate the prediction of malignant papillary lesions based on sonographic features.

METHODS

Review of 130 papillary lesions diagnosed on core needle biopsy (2002-2008) in 110 patients. The biopsy results were compared with final surgical pathology or evolution on imaging follow-up. Lesion size, patient age, type of biopsy needle and guidance, and length of imaging follow-up were documented. Sonographic features were retrospectively reviewed according to the BI-RADS lexicon. Morphology, not part of BI-RADS, was assessed as intraductal, intracystic, or solid.

RESULTS

Of the 130 papillary lesions, 6 were sampled with an 11-G vacuum-assisted needle under stereotactic guidance and the remaining 124 were sampled under US guidance with a 14-G (n = 115), 18-G (n = 8), or 10-G (n = 1) needle. Initial core needle biopsy diagnosis was benign (n = 103), showed atypia (n = 20), or malignancy (n = 7). Thirty-seven (36%) benign lesions were surgically excised and 66 (64%) were followed up. On final outcome, 10 benign lesions were upgraded to malignancy (9.7%) and 3 to atypia (3.6%). There was no significant difference in the benign, malignant, and upgraded groups with respect to size, age, or BI-RADS sonographic characteristics. None of the oval-shaped lesions nor the intraductal ones were upgraded.

CONCLUSIONS

Although some sonographic features could favor a benign diagnosis, when a core biopsy yields the diagnosis of a papillary lesion, surgical excision is recommended to definitely exclude malignancy.