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Asymptomatic Benign Papilloma Without Atypia Diagnosed at Ultrasonography-Guided 14-Gauge Core Needle Biopsy: Which Subgroup can be Managed by Observation?

 Soo-Yeon Kim  ;  Eun-Kyung Kim  ;  Hye Sun Lee  ;  Min Jung Kim  ;  Jung Hyun Yoon  ;  Ja Seung Koo  ;  Hee Jung Moon 
 ANNALS OF SURGICAL ONCOLOGY, Vol.23(6) : 1860-1866, 2016 
Journal Title
Issue Date
Adult ; Aged ; Biopsy, Large-Core Needle ; Breast Neoplasms/diagnosis* ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/surgery ; Carcinoma, Intraductal, Noninfiltrating/diagnosis* ; Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging ; Carcinoma, Intraductal, Noninfiltrating/surgery ; Disease Management ; Female ; Follow-Up Studies ; Humans ; Image-Guided Biopsy/methods* ; Middle Aged ; Neoplasm Invasiveness ; Observational Studies as Topic ; Papilloma/diagnosis* ; Papilloma/diagnostic imaging ; Papilloma/surgery ; Prognosis ; Prospective Studies ; Ultrasonography, Mammary/methods* ; Young Adult
BACKGROUND: For asymptomatic benign papillomas detected at ultrasonography-guided 14-gauge core-needle biopsy (US-CNB), the decision to perform excision versus observation has been a topic of debate. We sought to determine which subgroup of asymptomatic benign papillomas without atypia diagnosed at US-CNB can be safely managed by observation versus immediate excision. MATERIALS: Overall, 230 asymptomatic benign papillomas in 197 women (mean age 46.6 ± 9.5 years; range 22-78), diagnosed at US-CNB using immunohistochemistry staining when needed and then managed by surgery (n = 144) or vacuum-assisted excision (VAE) with at least 12 months of follow-up after benign VAE results (n = 86) were included in this study. The upgrade rate to malignancy was calculated. Clinical and radiological variables, including age, size, Breast Image Reporting and Data System (BI-RADS) category, and imaging-pathology correlation were evaluated to find associations with malignancy using multivariate analysis. RESULTS: The upgrade rate to malignancy was 2.6 % (6 of 230): four were ductal carcinomas in situ and two were 1.5- and 9-mm-sized invasive ductal carcinomas without lymph node metastasis. The upgrade rates of papillomas with a BI-RADS category 3-4a and imaging-pathology concordance were 1.4 and 1.8 %, respectively. Category 4b-5 and imaging-pathology discordance were independently associated with malignancy, with upgrade rates of 13 and 50 %, respectively. Age and lesion size were not associated with malignancy. CONCLUSION: Asymptomatic benign papillomas with probable benign or low suspicious US features or imaging-pathology concordance can be followed-up as opposed to immediate excision.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Koo, Ja Seung(구자승) ORCID logo https://orcid.org/0000-0003-4546-4709
Kim, Min Jung(김민정) ORCID logo https://orcid.org/0000-0003-4949-1237
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Moon, Hee Jung(문희정) ORCID logo https://orcid.org/0000-0002-5643-5885
Yoon, Jung Hyun(윤정현) ORCID logo https://orcid.org/0000-0002-2100-3513
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
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