The diagnosis of non-malignant papillary lesions of the breast: comparison of ultrasound-guided automated gun biopsy and vacuum-assisted removal

The diagnosis of non-malignant papillary lesions of the breast: comparison of ultrasound-guided automated gun biopsy and vacuum-assisted removal
M.J. Kima, S.-I. Kimb, J.H. Youka, H.J. Moona, J.Y. Kwaka, B.-W. Parkb and E.-K. Kim

Clinical Radiology 2011 66;6:530-535

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Out of 271 papillary lesions, 195 (80.0%) were benign, 21 (7.7%) were atypical, and 55 (20.3%) were malignant. There were no false negatives or underestimated atypical papillomas in the VAR group. However, in the ACNB group, the false-negative rate was 7.6% (12 of 157 benign papillomas, 95% CI; 4.4–12.9%, p = 0.039) and the atypical papilloma underestimation rate was 33% (five of 15 atypical papillomas, 95% CI; 15.2–58.3%, p = 0.135). The histological upgrade rates of the diagnosis for papillary breast lesions were 0% for the VAR (0 of 66) group and 10.2% for the ACNB (21 of 206) group before adjusting for the population (p = 0.003).

ACNB was associated with significantly higher false-negative and histological upgrade rates of diagnosis for papillary breast lesions than VAR.

Criteria for the safe avoidance of needle sampling in young women with solid breast masses

Criteria for the safe avoidance of needle sampling in young women with solid breast masses
A.J. Maxwell, J.M. Pearson
Clinical Radiology 2010 65;3:218-222

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Nine women with breast cancer, seven with phyllodes, and six with papillomas were found.

No delayed diagnoses in those who had ultrasound would have been made if the following criteria had been applied to avoid needle sampling:

• age less than 25 years
• no known risk factors for breast malignancy
• mass not rapidly enlarging
• smooth discrete mobile mass on clinical examination, or lesion impalpable
• well-defined homogeneously isoechoic or mildly hypoechoic solid mass
• less than 3 cm in greatest dimension
• ovoid shape, aligned parallel to the skin surface
• smooth or gently lobulated contour (two or three lobulations only; no microlobulation
• thin echogenic pseudocapsule
• no calcification
• no acoustic shadowing

Needle sampling could have been safely avoided in approximately two-thirds of the women reviewed below the age of 25 with a solid breast mass