OBJECTIVE: We wanted to assess the need for surgical excising papillary lesions of the breast that were diagnosed upon sonographically guided 14-gauge core needle biopsy. MATERIALS AND METHODS: Sixty-nine women (age range: 25-74 years, mean age: 51.7 years) with 69 papillary lesions (4.9%) were diagnosed and followed after performing sonographically guided 14-gauge core needle biopsies. Surgical excision was performed for 44 (64%) of 69 papillary lesions, and 25 lesions were followed with imaging studies (range: 6-46 months, mean: 17.9 months). The histologic findings upon core biopsy were compared with the surgical, imaging and follow-up findings. RESULTS: Core needle biopsies of 69 lesions yielded tissue that was classified as benign for 43 lesions, atypical for 18 lesions and malignant for eight lesions. Of the 43 lesions that yielded benign papilloma upon core needle biopsy, one had intraductal papillary carcinoma found upon surgery. An immediate surgical biopsy was recommended for this lesion because of the imaging-histologic discordance. No additional carcinoma was found during the imaging follow-up. Surgical excision was performed for 17 atypical papillary lesions, and this revealed intraductal (n = 6) or invasive (n = 2) papillary carcinoma in 8 (47%) lesions. Of the seven intraductal papillary carcinomas, surgery revealed invasive papillary carcinoma in one (14%). CONCLUSION: Our results suggest that papillary lesions of the breast that are diagnosed as benign upon sonographically guided 14-gauge core needle biopsy can be followed when the results are concordant with the imaging findings.
Adult ; Aged ; Biopsy, Fine-Needle ; Breast/*pathology/surgery ; Breast Neoplasms/*pathology/surgery ; Carcinoma/pathology/surgery ; Female ; Humans ; Middle Aged ; Papilloma, Intraductal/*pathology/surgery ; Retrospective Studies ; *Ultrasonography, Interventional

OBJECTIVE: To evaluate whether the removal of an intraductal mass using an ultrasound (US)-guided directional vacuum-assisted device can eliminate symptoms in patients presenting with abnormal nipple discharge. MATERIALS AND METHODS: Between March 2004 and October 2006, 36 patients who presented with abnormal nipple discharge, underwent US-guided, 11-gauge vacuum-assisted biopsy for a benign intraductal single mass on US. The ability of the procedure to eliminate nipple discharge was evaluated by physical examination during follow-up US. Lesion characteristics, biopsy variables, and histologic features were analyzed to identify factors affecting symptom resolution. RESULTS: Of the 36 lesions, 25 (69%) were intraductal papillomas, 10 (28%) were fibrocystic changes, and one (3%) was a fibroadenoma. The nipple discharge disappeared in 69% (25 of 36) of the women at a mean follow-up time of 25 months (range 12-42 month). There was no difference in the lesion characteristics, biopsy variables, and the histologic features between groups that eliminated the symptom compared those with persistent nipple discharge. CONCLUSION: US-guided directional vacuum-assisted removal of an intraductal mass appears to eliminate nipple discharge in only 69% of patients and thus, it should not be considered as an alternative to surgical excision.
Adult ; Biopsy/*methods ; Breast Neoplasms/pathology/*ultrasonography ; Chi-Square Distribution ; Exudates and Transudates/*ultrasonography ; Female ; Humans ; Mammography ; Middle Aged ; Nipples/pathology/*ultrasonography ; Papilloma, Intraductal/pathology/*ultrasonography ; Retrospective Studies ; *Ultrasonography, Interventional ; *Ultrasonography, Mammary ; Vacuum

PURPOSE: The Mammotome(R) biopsy is a relatively new surgical technique that is a minimally invasive image-guided procedure, requiring a small incision that produces a barely noticeable scar. The technique is a useful method for the surgical biopsy of properly selected patients. We reviewed the pathology of the biopsies for the proper selection of a mammotome biopsy in patients with re-excised breast tumors. METHODS: During a 24-month period, we performed vacuumassisted breast biopsies for 277 likely benign breast lesions using ultrasound and fine-needle aspiration cytology or a core needle biopsy, in 203 patients. The age of the patients ranged from 15 to 67 yr (average age 36.6 yr), and the average size of the lesions was 2.39+/-1.06 cm (minimum size 0.5 cm, maximum size 5.0 cm). We retrospectively analyzed the pathological findings of the re-excised breast lesions. RESULTS: The pathology of ultrasound-guided vacuum biopsies of the benign-appearing breast lesions were fibroadenomas (69.7%), intraductal papillomas (6.1%), fibrocystic disease (7.9%), phyllodes tumors (2.9%), malignant tumors (1.4%), ductal hyperplasia (2.9%), and other benign diseases (9.1%). Re-excision by a conventional method was performed for nine patients. Reasons for re-excision were the presence of five proven malignancies (a malignant phyllodes tumor in 2 cases, a tubular carcinoma in 1 case, a papillary carcinoma in 1 case and a ductal carcinoma in situ [DCIS] in 1 case), a possible atypical ductal hyperplasia (ADH) malignancy, two marginal involvement in phyllodes tumors and the possible extension of a lesion as an atypical papilloma. In the re-excised specimens, residual tissues were noticed in eight cases. An ADH lesion was proven as a DCIS. CONCLUSION: A case of suggested marginal involvements and/or a possible malignancy should be re-excised because of the high possibility of remnant lesions being present after the mammotome biopsy. The cytological and pathological review must be performed precisely before performing the mammotome procedures with considering of the clinical and radiological findings.
Adenocarcinoma ; Biopsy* ; Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Breast Neoplasms ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Papillary ; Cicatrix ; Fibroadenoma ; Humans ; Hyperplasia ; Papilloma ; Papilloma, Intraductal ; Pathology ; Phyllodes Tumor ; Retrospective Studies ; Ultrasonography ; Vacuum