Management of breast papillary lesions diagnosed in ultrasound‐guided vacuum‐assisted and core needle biopsies

<jats:sec><jats:title>Aims</jats:title><jats:p>To assess the outcome of breast papillary lesions diagnosed by ultrasound‐guided core needle biopsy (<jats:styled-content style="fixed-case">CB</jats:styled-content>) or vacuum‐assisted ‘mammotome’ biopsy (<jats:styled-content style="fixed-case">MT</jats:styled-content>), the accuracy of these diagnoses, and whether it is justified not to undertake surgical excision of non‐malignant papillary lesions so diagnosed.</jats:p></jats:sec><jats:sec><jats:title>Methods and results</jats:title><jats:p>Among 3219 (<jats:styled-content style="fixed-case">MT</jats:styled-content>, 2195; <jats:styled-content style="fixed-case">CB</jats:styled-content>, 1024) breast biopsies spanning 5 years, 185 (5.7%) papillary lesions [<jats:styled-content style="fixed-case">MT</jats:styled-content>, 162 (88%); <jats:styled-content style="fixed-case">CB</jats:styled-content>, 23 (12%)] were identified. Of these, 142 cases (77%; <jats:styled-content style="fixed-case">MT</jats:styled-content>/<jats:styled-content style="fixed-case">CB</jats:styled-content>, 125/17) were benign, 24 (13%, 23/1) were atypical, and 19 (10%; 14/5) were malignant. Of the 142 benign cases, 114 had imaging follow‐up (<jats:styled-content style="fixed-case">FU</jats:styled-content>) (<jats:styled-content style="fixed-case">FU</jats:styled-content> period 2–81 months); 17 of 114 cases were excised, and four were malignant (3.5%) (<jats:styled-content style="fixed-case">FU</jats:styled-content> period 4–57 months). Of the 24 atypical cases (23 had <jats:styled-content style="fixed-case">FU</jats:styled-content>), 19 were excised: six were benign (32%) and 13 malignant (68%). The remaining four cases were considered to be non‐malignant (<jats:styled-content style="fixed-case">FU</jats:styled-content> period 7–54 months).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Benign papillary lesions diagnosed by <jats:styled-content style="fixed-case">MT</jats:styled-content> or <jats:styled-content style="fixed-case">CB</jats:styled-content> might not require immediate excision, but should receive imaging <jats:styled-content style="fixed-case">FU</jats:styled-content> for at least 5 years. Excision should be performed in cases showing changes in imaging features, as the possibilities of carcinoma coexisting with papilloma or carcinoma developing from papilloma cannot be excluded, as illustrated by the 4% upgrade rate at excision in this study.</jats:p></jats:sec>