Management of Ultrasonographically Detected Benign Papillomas of the Breast at Core Needle Biopsy

OBJECTIVE. The purpose of this study is to retrospectively assess the upgrade rate determined by surgery for sonographically detected benign papillomas at core needle biopsy. MATERIALS AND METHODS. Sixty-four benign papillomas, detected during screening ultrasound and diagnosed at ultrasound-guided core needle biopsy in 58 patients (mean age, 44.6 years; range, 30-67 years), were surgically excised. The upgrade rate to atypical lesion and malignancy was determined on a per-lesion basis. Statistical analysis was performed to evaluate whether patients' age and lesion variables (i.e., size, distance from the nipple, and ultrasound findings) affected the upgrade rate. RESULTS. Surgical excision revealed the presence of benign papillomas in 43 cases, no residual lesion in 12 cases, atypical papillomas in seven cases, and papillary ductal carcinoma in situ in two cases. The upgrade rates to atypical papilloma and to malignancy were 10.9% (7/64; 95% CI, 4.51-21.3%) and 3.1% (2/64; 95% CI, 0.38-10.8%), respectively. Mean lesion size was significantly larger for lesions that were upgraded to malignancies (1.4 cm vs 0.9 cm) (p = 0.04). Age, distance from the nipple, and ultrasound findings were not significantly associated with underestimation of atypical lesions or malignancies after excision (p > 0.05). CONCLUSION. Our results show that the upgrade rate to malignancy determined by surgery for ultrasound-detected benign papillomas at core needle biopsy was 3.1% (2/64). Accordingly, for the accurate diagnosis of ultrasound-detected benign papillomas at core needle biopsy, surgical excision is recommended.