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Acad Radiol. 2018 Oct 6. pii: S1076-6332(18)30412-4. doi: 10.1016/j.acra.2018.08.014. [Epub ahead of print]

Management of BIRADS 3, 4A, and 4B Lesions Diagnosed as Pure Papilloma by Ultrasound-Guided Core Needle Biopsy: Is Surgical Excision Necessary?

Author information

1
American Radiology Associates, Baylor University Medical Center, 712N. Washington, Suite 101, Dallas, TX 75246. Electronic address: sean.raj@gmail.com.
2
Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215. Electronic address: jphilli2@bidmc.harvard.edu.
3
Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215. Electronic address: tmehta@bidmc.harvard.edu.
4
Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215. Electronic address: lmquina@bidmc.harvard.edu.
5
Belkin Breast Imaging Center, Boston Medical Center, Moakley Building, 830 Harrison Avenue,1st Floor, Boston, MA 02118. Electronic address: Michael.fishman@bmc.org.
6
Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215. Electronic address: vdialani@bidmc.harvard.edu.
7
Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215. Electronic address: pslanetz@bidmc.harvard.edu.

Abstract

RATIONALE AND OBJECTIVES:

There is lack of consensus on managing papillomas due to varied upgrade rates in the literature related to variability in the studied populations. We specifically studied upgrade rates of pure papilloma diagnosed with ultrasound core biopsy (UCB) using spring-loaded (SLB) and vacuum-assisted (VAB) biopsy devices in patients with low-to-intermediate pre-test probability for malignancy on imaging.

MATERIALS & METHODS:

From 01/01/2008 to 06/30/2016, 227 patients with 248 pure papillomas classified as BI-RADS 3, 4a, and 4b were diagnosed by UCB and underwent surgical excision or clinical and/or imaging follow-up. Imaging features, biopsy device, and final pathology were documented.

RESULTS:

177 lesions were biopsied with SLB (14-gauge) and 71 lesions with VAB (9-13 gauges). At surgery, upgrade rates to high-risk lesions and malignancy for SLB were 14.3% (22/154) and 1.9% (3/154), and for VAB were 3.5% (2/57) and 0% (0/57), respectively (p <0.05). The combined surgical upgrade rate to high-risk lesions and malignancy was 11.4% (24/211) and 1.4% (3/211), respectively. The overall upgrade rate (including surgical and clinical and/or imaging follow-up) to high-risk lesions and malignancy was 9.7% (24/248) and 1.2% (3/248), respectively. No ultrasound features were predictive of upgrade. Rates of complete excision were 7.1% (11/154) for SLB and 19.3% (11/57) for VAB (p < 0.05).

CONCLUSION:

BI-RADS 3, 4a, or 4b masses biopsied with UCB revealed pure papilloma upgrade to malignancy in less than 2% of cases. SLB was associated with greater upgrades compared with VAB. Therefore, follow-up imaging is a reasonable alternative to excision, particular in those sampled by VAB. Excision could be considered if the diagnosis of a high-risk lesion would change clinical management.

KEYWORDS:

Papilloma; Ultrasound; Ultrasound guided core biopsy; Upgrade rates

PMID:
30297308
DOI:
10.1016/j.acra.2018.08.014

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