OBJECTIVETo evaluate the underestimation of papillary breast lesions diagnosed at ultrasound-guided breast biopsy.

METHODSTotally 4453 ultrasound-guided visible breast lesions that were identified in the Department of Ultrasound, Chinese PLA General Hospital, from April 2005 to April 2012 were retrospectively reviewed. Of 207 papillary lesions that were detected by histologic findings of ultrasound-guided core needle biopsy(US-CNB), 90 underwent surgical excision, 110 were followed up for at least one year, and 7 were lost to follow-up. The histological findings of the US-CNB and the findings of surgical excision were compared to analyze the underestimation rates according to the Breast Imaging Reporting and Data System(BI-RADS)categories of American College of Radiology(ACR)and biopsy methods.

RESULTSOf the 90 papillary lesions underwent surgical excision, 29(32.2%)were underestimated, and 22 malignant lesions were underestimated(24.4%). Of the 23 papillomata with atypical ductal hyperplasia(IDP+ADH), 11(47.8%)were upgraded to malignant. Of the 137 benign intraductal papilloma(IDP)with concordance imaging-histologic findings, 8 lesions were underestimated(5.8%), whereas 10 out of 25(40.0%)IDP with diacordant imaging-histologic findings were underestimated. In total, 17.9% understimation were biopsied by 18G core needle biopsy(CNB)(P=0.017)and 16.0% by 16G CNB(P=0.023), which were significantly higher than vacuum-assisted biopsy(VAB).

CONCLUSIONSVAB is more accurate than 16G or 18G CNB in detecting papillary breast lesions. For high underestimations of IDP+ADH and IDP with discordant imaging-histologic findings, VAB or surgical excisions should be performed.