Follow-up imaging a smart choice after low-risk, moderate-risk breast lesions diagnosed as pure papilloma
When a low or moderate-risk breast lesion is diagnosed as pure papilloma following ultrasound core biopsy, what’s the next step in managing that patient’s care? Follow-up imaging is a reasonable alternative to surgical excision, according to a new study published in Academic Radiology, though other factors may dictate that excision is still the smartest option.
The authors studied data from 227 patients with 248 pure papillomas from 2008 to 2016. All lesions were classified as Breast Imaging Reporting and Data System (BI-RADS) categories 3, 4A or 4B. Overall, 177 lesions were biopsied with spring-loaded biopsy (SLB) and 71 were biopsied with vacuum-assisted biopsy (VAB).
The upgrade rates to high-risk legions and malignancy after SLB were 14.3 percent and 1.9 percent, respectively. The upgrades rates to high-risk legions and malignancy after VAB were 3.5 percent and 0 percent, respectively. Combined, the surgical upgrade rates to high-risk legions and malignancy were 11.4 percent and 1.4 percent.
“These findings confirm that follow-up imaging for pure papilloma classified as BIRADS 3, 4A, or 4B on ultrasound and diagnosed by UCB is a reasonable alternative to excision,” wrote Sean D. Raj, MD, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, and colleagues. “However, if the presence of a high-risk lesion at excision would change patient management, including use of chemoprophylaxis, surgical excision of pure papilloma diagnosed on UCB should be considered.”
The authors noted that their study did have limitations. For example, it was retrospective and from a single institution. Also, the BI-RADS assessments were all “subjective to the radiologist interpreting the study," the authors noted.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.