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Papillary lesions of the breast may be heterogeneous and associated with atypia or frank malignancy. Current practice is to perform wider sampling of lesions showing benign papilloma on core biopsy because of the risk of underestimation of disease. The literature, however, is unclear about the negative predictive value (NPV) of 14-gauge needle core biopsy for atypia or malignancy.
A retrospective review of image-guided biopsies performed over an 11-year period from January 1999 to December 2009 was undertaken. We identified cases with a 14-gauge core biopsy diagnosis of benign papilloma. Patients with atypia or malignancy on core biopsy were excluded. The imaging features and number of core samples were documented. All patients subsequently underwent lesion excision.
Seventy-eight patients had a diagnosis of a benign papilloma on core biopsy. Subsequent excision was with vacuum-assisted biopsy in 48 and surgery in 30. Twenty-eight patients with microcalcification had a stereo-tactic-guided biopsy. Fifty patients with a mass had ultrasound-guided biopsy. Atypical ductal hyperplasia was found in three out of 28 (11%) who had microcalcification (mean number of 10 cores) and one out of 50 (2%) with a mass (mean number of three cores). Seventy-four (95%) patients had a benign papilloma only.
The NPV for atypia and malignancy of 14-gauge core biopsy of papillomas is 95% in this series. Underestimation of disease is more common in lesions presenting with microcalcification. The current practice of wider sampling of all papillary lesions diagnosed on 14-gauge core biopsy should continue.