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Ultrasonography-guided core needle biopsy in differential diagnosis of papillary breast tumors
Acta Radiologica, 06/02/09

Bode MK et al. - In a trial to assess mammographic, sonographic, and core needle biopsy (CNB) findings of papillary lesions, and to correlate them with final histology obtained by surgical excision, it was concluded that the probability of malignancy is low when the CNB shows a benign papillary lesion with no atypia. The only way to reliably diagnose atypical papillary lesions is to surgically remove all papillary tumors, irrespective of CNB result. Differentiation between benign and malignant lesions or malignant noninvasive and invasive tumors is not possible based on sonographic or mammographic appearance.

Methods

From 2000-2006, 29 benign and 19 malignant papillary tumors examined with CNB were surgically removed.
Mammographic, sonographic, and CNB results were analyzed and correlated with final histology.

Results

On ultrasonography (US), 69% (20/29) of benign lesions were solid and 31% (9/29) were cystic, and 47% of malignant lesions (9/19) were solid and 53% (10/19) were cystic.
Mammographic findings were nonspecific, although most of the malignant tumors (67%, 12/18) were categorized as BI-RADS 4 lesions.
Sensitivity, specificity, and positive predictive value of the core needle biopsy histology was 32% (6/19), 100% (29/29), and 100% (6/6), respectively, for papillary carcinoma.
A negative predictive value of 91% (21/23) for malignancy and 48% (11/23) for either atypia or malignancy was shown.
Of the lesions with CNB diagnosis of benign papillary lesion with atypia, 58% (11/19) were malignant and 11% (2/19) were benign on surgery.

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