Percutaneous large-core biopsy of papillary breast lesions

OBJECTIVE. This study was undertaken to assess the accuracy of percutaneous large core biopsy in evaluating papillary breast lesions. MATERIALS AND METHODS. A retrospective review of imaging-guided large-core breast biopsy of 1077 consecutive lesions revealed that papillary lesions w ere diagnosed in 34 (3%) cases. Surgical correlation (n = 22) or minimum 2 years' mammographic follow-up (n = 4) were available for 26 papillary lesio ns. Mammographic and histologic findings in these 26 cases were reviewed. RESULTS. Percutaneous biopsy histology had benign findings in nine lesions, atypical in 10, and malignant in seven. Of seven lesions yielding benign p apilloma at percutaneous biopsy, none (0%) had carcinoma at surgery or mamm ographic follow-up. Surgery revealed carcinoma in one of two lesions yieldi ng papillomatosis at percutaneous biopsy. This lesion was a spiculated mass ; surgical biopsy, recommended because of mammographic-histologic discordan ce, revealed a radial sclerosing lesion and ductal carcinoma in situ (DCIS) . Of 10 papillary lesions with atypical ductal hyperplasia at percutaneous biopsy, surgery revealed DCIS in three (30%). Of seven lesions in which per cutaneous biopsy yielded papillary DCIS, surgery revealed DCIS in all seven ; three (43%) also had invasive carcinoma. CONCLUSION. Among our patients, diagnosis by percutaneous core biopsy of be nign papillary lesions proved to be accurate when concordant with imaging f indings. Surgical excision was indicated when diagnosis by percutaneous bio psy revealed atypical papillary lesions or papillary DCIS. A larger series with longer follow-up is required to assess the clinical course of benign p apillary lesions without atypia that are not excised after percutaneous lar ge-core breast biopsy.