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Breast Imaging

E3085. Needle Core Biopsy Diagnosis of Papillary Lesions: Is Surgical Excision Necessary?

Chhadia S1,  Stimpson R1,  Yedavalli V1,  Kirshenbaum K.1,2 1. Advocate Illinois Masonic Medical Center, Chicago, IL; 2. Good Shepherd Hospital, Barrington, IL

Address correspondence to R. Stimpson (rpstimp@gmail.com)

Objective: Management of intraductal papillomas has been a surgical dilemma. The purpose of this study is to determine the utility of surgical intervention in the setting of core needle biopsy–proven benign intraductal papillomas. Additionally, we sought to use imaging characteristics with BI-RADS classification to help guide further management of core needle biopsy–proven benign intraductal papillomas to prevent unnecessary surgical intervention.

Materials and Methods: A multiinstitution retrospective analysis was performed of all benign intraductal papillomas diagnosed with core needle biopsies completed from January 1, 2012, to July 31, 2016. Patients were included if they underwent subsequent surgical intervention or if follow-up imaging demonstrated stability over a 2-year period. A total of 85 female patients with ages ranging from 31–83 years were included. The imaging was reviewed, and core needle biopsies were performed by radiologists with an average of 13 years of breast imaging experience. Breast surgeons performed all surgical interventions and pathologists reviewed pathology independently. Mammographic and sonographic imaging, BI-RADS designation, biopsy and surgical pathology, concordance of results, and negative predictive value of core needle biopsy were analyzed.

Results: Of the original 96 patients with biopsy-proven intraductal papilloma, 11 were lost to follow-up. Rates of BI-RADS categories 4A, 4B, 4C, and 5 for the remaining 85 patients were 49.4% (n = 42), 41.2% (n = 35), 7.0% (n = 6), and 2.4% (n = 2), respectively. Of 85 patients, 78 had surgical pathology concordant with core needle biopsy results, five patients had no subsequent surgical intervention but had stability of imaging over a 2-year period indicating benign pathology, and two patients had surgical pathology compatible with papillary carcinoma, which was discordant with core needle biopsy results. Upon imaging review, the two patients with papillary carcinoma on surgical pathology also had a BI-RADS category 5 designation, with core biopsy results deemed to be discordant with core biopsy results. No papillary carcinoma was detected surgically on patients with a BI-RADS category 4 designation. The negative predictive value of core needle biopsy was 97.6%, including those patients who were followed successfully over a 2-year period.

Conclusion: Negative predictive value of core needle biopsy in the detection of benign intraductal papilloma was 97.6%. Upon review, 83 of 85 patients had stable imaging over 2 years or surgical pathology concordant with core needle biopsy results and BI-RADS category 4 designation, deeming surgical intervention unnecessary. Two of 85 patients had surgical pathology (papillary carcinoma) discordant with core needle biopsy results but had BI-RADS category 5 designation, which would have necessitated surgical excision. These findings stress the importance of utilizing imaging findings and BI-RADS classification in determining further management of biopsy-proven benign intraductal papillomas and preventing unnecessary surgical intervention. Our results suggest a need to further investigate the management of benign papillary lesions diagnosed on core biopsy, with a potential role for conservative follow-up in cases with low-risk imaging features and benign core needle biopsy results. Benefits of conservative follow-up in these cases would include reduced patient anxiety, postsurgical complications, and economic costs.