Large-volume Mammotome biopsy may reduce the need for surgery in screen-detected papillary lesions
© BioMed Central Ltd 2008
Published: 7 July 2008
The majority of papillary breast lesions diagnosed on conventional needle-core biopsy are classified B3 – of uncertain malignant potential. There is currently debate whether such lesions require surgical excision, particularly if there is no epithelial atypia. The risk of associated malignancy is low.
Large-volume Mammotome (Ethicon Endo-Surgery, Cincinnati, OH, USA) biopsy can sample lesions more extensively, obviating the need for surgery in some cases. We review the impact of adopting this approach for the management of screen-detected B3 papillary lesions without atypia.
Fifteen patients presenting through the Pennine Breast Screening Programme between 19 December 2005 and 23 August 2007 had core biopsies containing a B3 papillary lesion without atypia. Mammographically, 12 patients had calcification and three presented masses. Three patients underwent surgical excision, 10 underwent Mammotome biopsy and two patients had no subsequent procedure.
All three patients undergoing surgery showed benign intraductal papillomata. Of the 10 patients undergoing Mammotome, eight were confirmed as benign. None subsequently developed malignancy. One Mammotome patient contained ductal carcinoma in situ (DCIS); another, an atypical epithelial proliferation resulting in surgery and a subsequent diagnosis of DCIS. Both cases were distinctive in presenting with segmental calcification, and in both DCIS had arisen in the context of multiple papillomata.
Large-volume Mammotome biopsy may reduce the need for surgery in selected screen-detected papillary lesions.