Although papillary lesions account for only 1% to 3% of all lesions sampled by core needle biopsies, a new study has found that it may be wise to treat these benign growths with much more care since they could be harboring pre-cancerous or even cancerous cells that pose an elevated risk of malignancy.
The study, published in the March issue of Radiology, indicates that some breast lesions diagnosed as benign on core needle biopsy turn out to have cancer when they undergo surgical excision. The researchers conclude that, because of this, it would be wise to remove them altogether.
According to lead author, Dr. Cecilia L. Mercado, assistant professor of radiology at New York University Medical Center in New York City, “Our study shows that all papillary lesions of the breast should be surgically excised to avoid missing a cancer.” (Medical News Today 3/2/06)
At present, the treatments of choice for these “benign†papillary lesions are surgical excision and radiographic follow-up, and even that is often dependant upon a doctor’s recommendation.
Dr Mercado says, “To date, the management of benign papillary lesions on core needle biopsy has been controversial and may be based on anecdotal evidence or small published studies. No definite guidelines are published for management of these lesions.”
The study found that these otherwise lesions may be problematic in that they can “harbor†adjacent atypical ductal hyperplasia (ADH), which is a condition characterized by cells of unusual size, shape, and number in the lining of the milk ducts, and ductal carcinoma in situ (DCIS), which are cancerous cells confined to the lining of the milk ducts.
Both of these conditions shave the potential to develop into malignancies in the future if left unchecked.
The team examined the imaging and follow-up findings in 42 patients diagnosed with benign papillary lesions after breast core needle biopsy. Of the 43 breast core needle biopsies performed, 36 (84%) of the lesions were removed surgically, and seven (16%) had long-term imaging follow-up. Nine of the 42 patients (21.4%) had their diagnoses upgraded to ADH or DCIS after surgical excision. This represented a much higher percentage than found in previous studies.
According to Dr. Mercado: “This is one of the largest series and shows statistically significant findings. The results of our study revealed a considerable upgrade rate to either ADH or DCIS at core-needle biopsy. Therefore, all benign papillary lesions of the breast should be surgically excised, since a considerable number of atypical lesions and malignant lesions could be missed.”
(Source: Medical News Today 3/2/06)
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