Breast lesions that are often deemed to be benign following a needle biopsy can still harbor adjacent cancers and should be removed anyway, United States researchers recommend.
"Our study shows that all papillary lesions of the breast should be surgically excised to avoid missing a cancer," says the lead author of the study, Dr. Cecilia L. Mercado, an assistant professor of radiology at New York University Medical Center.
Papillary lesions, which account for 1% to 3% of all lesions sampled by core needle biopsies, are benign growths in the duct of the breast. Current treatment for these lesions includes radiographic follow-up and surgical removal, depending on each doctor's recommendation.
While these lesions may be diagnosed as benign, they can harbor adjacent atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS)-cancerous cells that are confined to the lining of the milk ducts. Left untreated, both of these conditions put a woman at an increased risk for cancer in the future.
For this study, the researchers analyzed the imaging and our comes of 42 patients who had been diagnosed with benign papillary lesions after core needle biopsy. Of the 43 biopsies that were performed, 35 (84%) of the lesions were surgically removed and seven (16%) received long-term imaging follow-up.
As a result of surgical removal of the lesion and laboratory follow-up, the diagnoses of nine of the 42 patients (21.4%) were changed to ADH or DCIS. That percentage is much higher than what has been reported in previous research.
"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," Mercado says. "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."
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