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Imaging-Guided Core Needle Biopsy of Papillary Lesions of the Breast

¹ Department of Radiology, Breast Imaging Division, Duke University Medical Center, Box 3808, Durham, NC 27710.
² Department of Pathology, Diagnostic Pathology Division, Duke University Medical Center, Box 3712, Durham, NC 27710.

View larger version (142K): [in a new window]   Fig. 1A. —69-year-old woman with false-positive diagnosis at core needle biopsy. Medial lateral oblique mammogram shows oval mass (arrows) in subareolar breast.

View larger version (139K): [in a new window]   Fig. 1B. —69-year-old woman with false-positive diagnosis at core needle biopsy. Sonogram reveals complex cystic mass (arrow) with solid component.

View larger version (104K): [in a new window]   Fig. 1C. —69-year-old woman with false-positive diagnosis at core needle biopsy. Sonogram shows core needle biopsy performed through solid component using sonographic guidance. Note biopsy needle traversing lesion.

View larger version (161K): [in a new window]   Fig. 1D. —69-year-old woman with false-positive diagnosis at core needle biopsy. Photograph of histologic specimen obtained at core needle biopsy shows irregular infiltrative-appearing small glands in desmoplastic stroma, interpreted initially as invasive ductal adenocarcinoma. Subsequent excision of this lesion revealed only benign intraductal papilloma with extensive sclerosis. (H and E, x200)

View larger version (168K): [in a new window]   Fig. 1E. —69-year-old woman with false-positive diagnosis at core needle biopsy. Photograph of immunoperoxidase stain on histologic specimen obtained at core needle biopsy shows circumferential staining around all glands, confirming presence of myoepithelial cell layer. Diagnosis was changed to benign intraductal papilloma. (x400)

View larger version (145K): [in a new window]   Fig. 2A. —68-year-old woman diagnosed with papillary carcinoma in situ at core needle biopsy and confirmed at excisional biopsy. Coned image of craniocaudal mammogram shows irregular mass with ill-defined margins and pleomorphic microcalcifications.

View larger version (32K): [in a new window]   Fig. 2B. —68-year-old woman diagnosed with papillary carcinoma in situ at core needle biopsy and confirmed at excisional biopsy. Stereotactic mammograms taken after firing biopsy gun and before biopsy confirm proper positioning of 11-gauge vacuum-assisted biopsy needle.

View larger version (151K): [in a new window]   Fig. 2C. —68-year-old woman diagnosed with papillary carcinoma in situ at core needle biopsy and confirmed at excisional biopsy. Photograph of histologic specimen obtained at core needle biopsy shows well-developed cribriform architecture in epithelial component of papillary lesion, diagnostic for papillary carcinoma in situ. (H and E, x100)

View larger version (180K): [in a new window]   Fig. 3A. —65-year-old woman with atypical papilloma found at core needle biopsy that was upgraded to papillary carcinoma in situ at excisional biopsy. Spot compression magnification mammogram shows clustered amorphous microcalcifications in focally dense breast parenchyma.

View larger version (155K): [in a new window]   Fig. 3B. —65-year-old woman with atypical papilloma found at core needle biopsy that was upgraded to papillary carcinoma in situ at excisional biopsy. Photograph of histologic specimen obtained at core needle biopsy shows atypical epithelial proliferation involving only part of biopsy (right half of field) specimen, leading to diagnosis of atypical papilloma. (H and E, x40)

View larger version (178K): [in a new window]   Fig. 3C. —65-year-old woman with atypical papilloma found at core needle biopsy that was upgraded to papillary carcinoma in situ at excisional biopsy. Photograph of histologic specimen obtained at excisional biopsy reveals papillary carcinoma in situ. (H and E, x100)

View larger version (137K): [in a new window]   Fig. 4A. —39-year-old woman with benign papilloma revealed at core needle biopsy that was upgraded to atypical papilloma at excisional biopsy. Spot compression mammogram reveals oval mass with mostly circumscribed margins in inferior subareolar breast.

View larger version (175K): [in a new window]   Fig. 4B. —39-year-old woman with benign papilloma revealed at core needle biopsy that was upgraded to atypical papilloma at excisional biopsy. Sonogram shows solid oval mass with ill-defined margins.

View larger version (140K): [in a new window]   Fig. 4C. —39-year-old woman with benign papilloma revealed at core needle biopsy that was upgraded to atypical papilloma at excisional biopsy. Photograph of histologic specimen obtained at core needle biopsy shows well-developed papillary architecture. (H and E, x40)

View larger version (164K): [in a new window]   Fig. 4D. —39-year-old woman with benign papilloma revealed at core needle biopsy that was upgraded to atypical papilloma at excisional biopsy. Photograph of histologic specimen from excisional biopsy shows intraductal papilloma with atypia. Punched-out spaces and monotonous cytology are shown in this high-power view. Elsewhere on specimen, papilloma shows only epithelial hyperplasia. Because atypical area is only focal, diagnosis is atypical papilloma. (H and E, x100)

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