Authors: Ja Seung Koo Kyunghwa Han Min Jung Kim Hee Jung Moon EunKyung Kim ByeongWoo Park
Publish Date: 2013/01/06
Volume: 137, Issue: 3, Pages: 797-806
Abstract
To evaluate whether the upgradetomalignancy rate of benign papillary lesions on ultrasonographically USguided 14gage core needle biopsy CNB can be decreased using immunohistochemistry staining IHC for pathologic diagnosis and to determine whether additional IHC can replace surgical excision for the diagnosis of papillary breast lesions classified as benign on 14gage CNB A total of 274 consecutive papillary lesions were studied including available imaging findings CNB specimens and surgical specimens Two rounds of retrospective review of the pathologic slides from CNB were performed by a pathologist including HE staining first round 1R n = 274 and IHC of the benign papillomas second round 2R The upgradetomalignancy rate was assessed for benign papillomas with comparison between 1R and 2R The final diagnosis was based on surgical pathology The clinicoradiologic findings were compared between the benign and malignant papillomas at the time of final diagnosis In 1R 204 benign papillomas were identified During 2R using IHC three carcinomas and ten atypical papillomas were diagnosed Among the 204 benign papillomas from 1R 15 were found to be carcinomas upgradetomalignancy rate 74 at the time of final diagnosis With 2R the overall upgradetomalignancy rate was decreased to 47 9/192 p = 03680 Older age and upgrades made after IHC review resulted in higher upgradetomalignancy rates odds ratio 4133 95 CI 1393–12267 p = 00106 13446 95 CI 17886–infinity p 00001 respectively The use of IHC may decrease the upgradetomalignancy rate for benign papillary lesions after USguided 14gage CNB and help to more accurately predict malignancy at the time of surgery Despite these findings a misdiagnosis still occurred in our study suggesting that IHC cannot replace surgical excision for diagnosis of benign papillary lesions of the breast
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