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Abstract
Purpose
We wanted to determine the underestimation rate of ultrasound (US)-guided 14-gauge core needle biopsy for papillary neoplasms that were treated with subsequent surgical excision or vacuum-assisted biopsy (VAB) and we also wanted to evaluate the sonographic findings of papillary neoplasms.
Methods
A retrospective review of the US-guided core needle biopsies of 984 consecutive lesions from January 2004 to April 2006 revealed 29 (3%) papillary neoplasms. Twenty five lesions were further excised by surgery (n=16) or VAB (n=9). The remaining 4 lesions were not further excised and they were excluded from this study. We evaluated the concordance between results of core needle biopsy and the final pathologic results. We reevaluate the sonographic findings of the papillary neoplasms included in our study.
Results
The pathologic results of core needle biopsy were benign in 21 and atypical in four. Of the 21 benign papillomas, none were revealed as carcinoma after further excision. Just one lesion showed focal atypical ductal hyperplasia (ADH) after VAB. Three intraductal papillomas with ADH underwent surgical excision (n=3) or VAB (n=1), and they were proved to be the same pathologic entities with (n=1) or without (n=3) lobular neoplasia. The sonographic findings were as follows: four intraductal masses, four intracystic masses, four solid masses with peripheral anechoic rims, five extraductal masses adjacent to dilated ducts, six pure solid masses, and two mixed masses.
Conclusion
US-guide 14-gauge core needle biopsy for papillary neoplasm showed no underestimation after surgical excision or VAB in our study, and the procedure proved to be reliable for the assessment of papillary neoplasm if the imaging and pathologic findings were concordant. Papillary neoplasms showed variable sonographic findings.
Figures and Tables
Fig 1
US categories of papillary neoplasms of breast. (A) Intraductal mass (n=4). (B) Intracystic mass (n=4). (C) Solid mass with peripheral anechoic rim (n=4). (D) Extraductal mass adjacent to the dilated duct (n=5). (E) Pure solid mass (n=6). (F) Mixed type (Intraductal+Extraductal masses) (n=2).
Fig 2
A 48-yr-old woman without specific symptom. US of left outer subareolar region shows mild ductectasia with an isoechoic intraductal lesion (arrows). Histopathology of core needle biopsy revealed an intraductal papilloma with atypical ductal hyperplasia. The lesion was surgically excised and confirmed as the same pathologic entity on core biopsy specimen with lobular neoplasia.
Fig 3
A 79-yr-old woman with a palpable breast mass. US of left mid upper breast reveals an about 1.7 cm-sized circumscribed oval cyst with an internal nodular isoechoic solid portion (arrow). With core needle biopsy of the solid portion, the lesion was revealed as a benign papilloma. After 11 gauge VAB, the lesion was confirmed as papilloma with atypical ductal hyperplasia.
Table 2
Correlation between sonographic BI-RADS categories and histologic findings at surgical excision or VAB
BI-RADS=Breast imaging reporting and data system; VAB=vacuum-assisted biopsy; C3=BI-RADS category 3, probably benign; C4A=BI-RADS category 4A, suspicious abnormality with low suspicion of malignancy; C4B=BI-RADS category 4B, suspicious abnormality with intermediate concern; IP=intraductal papilloma; UDH=usual ductal hyperplasia; ADH=atypical ductal hyperplasia; LN=lobular neoplasia.
*Corrected pathology after surgical excision or VAB.
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