B3 core biopsy suspicious of a papilloma: how should we proceed?

Aim: Papillomatous lesions of the breast, with or without atypia, are often reported as a B3 on core biopsy and proceed to surgical excision. This audit aimed to retrospectively assess the propensity for neoplasia to occur and whether surgical excision is appropriate.

Methods: A database of patients with a B3 core biopsy at a single Breast Unit between October 2005 and April 2012 was searched. Core biopsies of papillomas scoring B3 with subsequent surgical excision were included. Demographic parameters including patient age, pre-and post-operative size, and presence of atypia were recorded. Subsequent development of cancer was identified from follow-up data. Analysis of the data was performed using SPSS.

Results: Fifty patients with a median age of 62 years had a median pre-operative and post-operative lesion size of 12mm and 40mm, respectively. Atypia was evidenced in 11 patients on core biopsy. DCIS was present in nine patients at the time of excision and three patients subsequently developed a cancer. There was a significant association between DCIS at the time of excision and subsequent invasive disease (p=0.048, Fisher's exact test).

Conclusion: A B3 core biopsy suggestive of a papilloma without evidence of atypia can safely be removed by large volume core biopsy.