Is Further Diagnostic Surgery Necessary for the Benign Papillary Lesions that Are Diagnosed by Large Volume Vacuum Assisted Breast Biopsy?

Hai-Lin Park; So Yong Chang; Jung Yin Huh; Ji Young Kim

doi:10.4048/jbc.2010.13.2.206

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Park, Chang, Huh, and Kim: Is Further Diagnostic Surgery Necessary for the Benign Papillary Lesions that Are Diagnosed by Large Volume Vacuum Assisted Breast Biopsy?

Original Article

Journal of Breast Cancer

Journal of Breast Cancer 2010; 13(2): 206-211.

Published online: 29 June 2010

DOI: https://doi.org/10.4048/jbc.2010.13.2.206

Is Further Diagnostic Surgery Necessary for the Benign Papillary Lesions that Are Diagnosed by Large Volume Vacuum Assisted Breast Biopsy?

Hai-Lin Park, So Yong Chang¹, Jung Yin Huh¹, Ji Young Kim²

Department of Surgery, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea.

¹Department of Radiology, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea.

²Department of Pathology, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea.

Corresponding author (phl1@cha.ac.kr)

Received 10 September 2009 Accepted 23 February 2010

Abstract

Purpose

There is ongoing controversy regarding the management of papillary lesions that are diagnosed by core needle biopsy (CNB). The development of vacuum assisted biopsy now permits non-operative removal of papillary breast lesions. Our aim was to evaluate whether the papillary lesions diagnosed by vacuum assisted breast biopsy (VABB) can be followed up without further diagnostic excision.

Methods

From January 2003 to July 2009, a total of 4,655 US-guided mammotome excision were performed in 3,714 patients at Kangnam CHA Hospital. Out of 4,655 lesions, 156 lesions were proved to be papillary lesions. Among these, 82 lesions that had histologic findings that were consistent with benign papillary lesions and that were followed up for more than 2 years without further diagnostic surgical excision were collected and retrospectively analyzed. Ultrasonographic follow-up was done at 3-6 month intervals to assess for recurrence. The mean follow up period was 49.6 months.

Results

The pathologic diagnoses for the 82 lesions obtained via VABB were benign intraductal papilloma and papillomatosis. Half of the lesions were palpable and 50.0% (41 cases) were nonpalpable. Twenty eight lesions (34.1%) were classified as BIRADS category 3, 50 lesions (61.0%) were category 4A, 3 lesions (3.7%) were category 4B and only 1 lesion (1.2%) was category 5 according to the ultrasound exams. No local recurrence developed during the follow up period that needed surgical re-excision or rebiopsy. None of those diagnosed as benign lesions at VABB were upgraded to a more advanced lesions.

Conclusion

The benign papillary lesions that are diagnosed and excised by mammotome may not need further diagnostic surgical re-excision if surgeons are sure that the targeted lesions were excised completely.

Keywords: Benign breast papillary lesions, Vacuum assisted breast biopsy

Figures and Tables

Table 1

Pathologic classification

Table 2

Age distribution of patients

Table 3

Tumor size distribution

Table 4

Distribution of BI-RADS category of mammography and palpability of benign papillary lesions

MMG=mammography; BI-RADS=Breast imaging reporting and data system.

Table 5

Tumor location distribution

UOQ=upper outer quadrant; UIQ=upper inner quadrant; LOQ=lower outer quadrant; LIQ=lower inner quadrant.

Table 6

Proportion of US result

R/O=rule out; IDP=intraductal papilloma.

Table 7

Ultrasound BI-RADS category distribution of benign papillary lesions

USG=ultrasonography.

Table 8

Correlation between the size, number of pieces and time of procedure

SD=standard deviation.

^*8G needle used; ^†includes 2 cases of 11G needle.

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