ArticleJournal of clinical imaging science2026
Papillary lesions of breast on core-needle biopsy: Factors associated with malignant upgrade on surgical excision.
Article in Journal of clinical imaging science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Papillary lesions (PLs) of the breast diagnosed on core-needle biopsy (CNB) pose a management dilemma due to their variable upgrade rates to malignancy. This study aims to identify predictors of malignant upgrade, facilitating risk stratification that may spare low-risk patients from unnecessary open surgery. Material and Methods: This retrospective study analyzed 219 CNB-diagnosed PLs in 172 female patients at a tertiary center from 2008 to 2022. Clinical parameters (age at diagnosis, single duct bloody nipple discharge, mastalgia), sonographic findings (multifocality, size, location, intraductal lesion, intralesional vascularity, margin, posterior features) and histopathologic findings (atypia) were analyzed with Fisher's exact test and multivariate logistic regression. Results: The overall upgrade rate to malignancy was 8.2% (18/219). Four independent predictors of upgrade were identified: lesion size ≥1 cm (Odds ratio [OR] 3.6, 95% confidence interval [CI] 1.0-12.3; Conclusion: Lesion size ≥1 cm, presence of intralesional vascularity, non-circumscribed margins, and atypia on CNB specimens are significant predictors of malignant upgrade in patients with PLs on CNB. Low-risk lesions (subcentimeter circumscribed lesions without vascularity and atypia) may be managed with minimally invasive approaches (e.g., vacuum-assisted excision) given their low upgrade rate (3.4%) and high negative predictive value (96.6%), while high-risk lesions (particularly those with atypia) warrant surgical excision.
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