Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy: Comparison of sonographic features and biopsy methods

OBJECTIVE. The objective of our study was to retrospectively assess the potential role of sonographic features and biopsy in the management of patients with papillary lesions diagnosed at percutaneous sonographically guided biopsy. MATERIALS AND METHODS. Surgical or sonographic follow-up (>= 2 years) was available in 123 women (age range, 21-75 years; mean age, 47 years) with 124 papillary lesions diagnosed at sonographically guided core needle or vacuum-assisted biopsy during a 7-year period. Surgical excision results or follow-up sonograms with no change at the 2-year follow-up served as the reference standard. We reviewed the sonographic features, biopsy results, and surgical or sonographic follow-up. Statistical analysis was performed using the Fisher's exact test for the difference of sonographic features. RESULTS. Cancer incidence per BI-RADS category was as follows: category 3, zero (0%) of 21; category 4a, 14 (17%) of 85; category 4b, four (36%) of 11; category 4c, one (20%) of five; and category 5, one (50%) of two. On sonography, two features distinguishing benign from malignant papillary lesions were echo pattern and margins of masses. Core needle biopsy gave a sensitivity of 28% and specificity of 100%, whereas both sensitivity and specificity were 100% with vacuum-assisted biopsy. Of 117 lesions with benign biopsy results, upgrade to malignancy or high-risk lesion was found in 17% of benign papillomas, 24% of atypical papillomas, and 0% of multiple papillomas. CONCLUSION. Vacuum-assisted biopsy was more accurate than core needle biopsy in diagnosing papillary lesions, and both sonographic features and core needle biopsy were not sufficiently accurate. Therefore, surgical excision should be performed for the accurate diagnosis of papillary lesions.