Atypical papilloma diagnosed by sonographically guided 14-gauge core needle biopsy of breast mass

OBJECTIVE. The purpose of this study was to evaluate the surgical outcome of atypical papilloma diagnosed by sonographically guided 14-gauge core needle biopsy of the breast mass and to determine whether clinical and radiologic features of this lesion could be used to predict an upgrade to malignancy. MATERIALS AND METHODS. We retrospectively reviewed the pathologic results of sonographically guided 14-gauge core needle biopsy for solid breast masses. A total of 30 atypical papillomas diagnosed by this procedure and surgically excised were included in this study. For each lesion, medical records, mammograms, and sonograms were reviewed, and clinical and radiologic variables were coded. The sonographic features were determined, and the BI-RADS assessment category was noted. We compared the rate of upgrade to malignancy among the collected variables. RESULTS. The results of surgical excision in 30 atypical papillomas were malignant in seven (23.3%) cases. In comparison of rates of upgrade to malignancy among clinical and radiologic variables, multiple lesions, increased vascularity, and higher sonographic BI-RADS category showed significantly higher upgrade rate. CONCLUSION. Atypical papilloma diagnosed by use of sonographically guided 14-gauge core needle biopsy showed a high upgrade rate after surgical excision. Although some sonographic features may be helpful to predict an upgrade to malignancy, atypical papilloma should be excised surgically in any case.