Lars J Grimm1, Christine E Bookhout2, Rex C Bentley3, Sheryl G Jordan4, Thomas J Lawton5. 1. Department of Radiology, Duke University, DUMC Box 3808, Durham, NC 27710, USA. Electronic address: lars.grimm@duke.edu. 2. Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, 101 Manning Dr, Cb #7525, Chapel Hill, NC 27514, USA. 3. Department of Pathology, Duke University, DUMC Box 3712, Durham, NC 27710, USA. 4. Department of Radiology, University of North Carolina at Chapel Hill, 430 Waterstone Drive, First Floor, Hillsborough, NC 27278, USA. 5. Department of Pathology and Laboratory Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
Abstract
PURPOSE: Non-atypical papillomas (NAPs) diagnosed on core needle biopsy (CNB) frequently undergo surgical excision due to highly variable upstaging rates. The purpose of this study is to document our dual-institution upgrade rates of NAPs diagnosed on core needle biopsy and review the upgrade rates reported in the literature. MATERIALS AND METHODS: Following IRB approval, CNB results from Duke University (7/1/2004-6/30/2014) and the University of North Carolina Chapel Hill (1/1/04-6/30/2013) were reviewed to identify non-atypical papillomas. All cases with surgical excision or 2 years of imaging follow up were included. In addition, a literature review identified 60 published studies on upgrades of NAPs diagnosed at CNB. Cases in our cohort and the published literature were reviewed for confounding factors: [1] missing radiologic-pathologic concordance and/or discordance, [2] papillomas included with high-risk lesions, [3] high risk lesions counted as upgrades, [4] review by a nonspecialized breast pathologist, and [5] cancer incidentally detected. RESULTS: Of the 388 CNBs in our dual-institution cohort, 136 (35%) patients underwent surgical excision and 252 (65%) patients had imaging follow up. After controlling for confounders, no cancers (0/388) were found at surgical excision or during follow up imaging. The literature review upstaging rate was 4.0% (166/4157) but 1.8% (4/227) after excluding studies with confounders. The combined upstaging rate from the literature and this study was 0.6% (4/615). CONCLUSION: The upstaging rate for CNB diagnosed NAPs was 0% in our cohort and 0.6% overall after adjusting for confounders. This low rate does not warrant reflexive surgical excision and diagnostic imaging follow up should be discretionary.
PURPOSE:Non-atypical papillomas (NAPs) diagnosed on core needle biopsy (CNB) frequently undergo surgical excision due to highly variable upstaging rates. The purpose of this study is to document our dual-institution upgrade rates of NAPs diagnosed on core needle biopsy and review the upgrade rates reported in the literature. MATERIALS AND METHODS: Following IRB approval, CNB results from Duke University (7/1/2004-6/30/2014) and the University of North Carolina Chapel Hill (1/1/04-6/30/2013) were reviewed to identify non-atypical papillomas. All cases with surgical excision or 2 years of imaging follow up were included. In addition, a literature review identified 60 published studies on upgrades of NAPs diagnosed at CNB. Cases in our cohort and the published literature were reviewed for confounding factors: [1] missing radiologic-pathologic concordance and/or discordance, [2] papillomas included with high-risk lesions, [3] high risk lesions counted as upgrades, [4] review by a nonspecialized breast pathologist, and [5] cancer incidentally detected. RESULTS: Of the 388 CNBs in our dual-institution cohort, 136 (35%) patients underwent surgical excision and 252 (65%) patients had imaging follow up. After controlling for confounders, no cancers (0/388) were found at surgical excision or during follow up imaging. The literature review upstaging rate was 4.0% (166/4157) but 1.8% (4/227) after excluding studies with confounders. The combined upstaging rate from the literature and this study was 0.6% (4/615). CONCLUSION: The upstaging rate for CNB diagnosed NAPs was 0% in our cohort and 0.6% overall after adjusting for confounders. This low rate does not warrant reflexive surgical excision and diagnostic imaging follow up should be discretionary.
Authors: Jacky D Luiten; Bram Korte; Adri C Voogd; Willem Vreuls; Ernest J T Luiten; Luc J Strobbe; Matthieu J C M Rutten; Menno L Plaisier; Paul N Lohle; Marianne J H Hooijen; Vivianne C G Tjan-Heijnen; Lucien E M Duijm Journal: Int J Cancer Date: 2019-05-02 Impact factor: 7.396
Authors: Ayşe Nur Uğur Kılınç; Zeynep Bayramoğlu; Yaşar Ünlü; Nahide Baran; Ayşegül Altunkeser; Nergis Aksoy; Mehmet Ali Eryılmaz; Elif Nur Öztürk Yıldırım Journal: Eur J Breast Health Date: 2021-06-24