Screen Detected Papillary Lesions of the Breast-A Retrospective Review from a Single Institution

To identify the diagnostic accuracy of imaging, fine need aspiration biopsy (FNAB) and core needle biopsy (CNB) in identifying papillary lesions in the setting of a population based mammographic screening program. A retrospective analysis of mammographic screening detected lesions diagnosed as papillary lesions on surgical excision at Breast Screen Sydney West between 1993 2010 was performed. Imaging, FNAB and CNB diagnoses were correlated with surgical excision pathology to determine the performance indicators. Two hundred and seventeen papillary lesions were identified with imaging and corresponding excision pathology with a final total of 153 FNAB and 105 CNB performed on these. ImagingOf the 143 designated benign/ equivocal 27 (19%) were upgraded to malignant. Thirty two (43.2%) of 74 image-designated suspicious or malignant were benign on excision. FNABFourteen (12.4%) of the 113 designated benign/atypical were upgraded to malignant. Eleven (27.5%) of 40 malignant FNAB were downgraded to benign on excision. CNBThree of 43 benign lesions were malignant on excision (upgrade rate 7%). One of 24 (4%) suspicious/ malignant was downgraded to benign. Complete sensitivity was high for FNAB and CNB95.2% and 91.7%, respectively. Absolute sensitivity was 42.8% for FNAB and 50% for CNB. Specificity for imaging, FNAB and CNB was 37.25%, 89.6% and 100% with accuracy rates of 60.4%, 85.5% and 95.0%, respectively. CNB has high complete sensitivity, specificity and accuracy, indicating a benign CNB diagnosis is highly predictive of a benign papillary lesion on surgical excision.