Breast Tumors Diagnosed as Papillary Neoplasm by FNAB

Dae-Kyum Kim, Sang-Uk Woo, Jeong-Han Kim, Seok-Jin Nam, Yoon-La Choi1 , Young-Lyun Oh1 and Jung-Hyun Yang

Department of Surgery and 1Pathology, Samsung Medical Center,Sungkyunkwan University, School of Medicine

Introduction

• Papillary neoplasm (PN) of the breast

• Fine Needle Aspiration Biosy (FNAB)

• PN and FNABPN and FNAB

- It is difficult to determinate their malignancy (Jeffrey and Ljung 1994)- Several other breast lesions may have similar features and may be misclassified as PN by FANB (Kline et al 1986, Naran et al 1988, Bardales et al 1994)

Methods

• Breast tumors diagnosed as “PN” by FNAB at Samsung Medical Center between Oct. 1994 and May 2004

• Retrospective study for 66 patients who underwent surgery - Diagnostic accuracy - Malignancy- Radiologic malignancy and pathologic results

• Radiologic malignancyRadiologic benign; BIRAD 1~3Radiologic malignant; BIRAD 4~5

• Statistics t testChi-square or Fisher’s exact test

Results1. Pathologic results for PN on

FNAB

0

5

10

15

20

25

30

35

40

Pathology

PN Non PN

No. of patients

n=37 n=37 (56.1%)(56.1%)

n=29 n=29 (43.9%)(43.9%)

2. Tumor Size

0

0.5

1

1.5

2

2.5

3

PN Non PN

Size (cm)

1.5cm1.5cm 2.8cm2.8cm

P=0.001P=0.001

Mean Mean size= size= 2.1 cm2.1 cm

3. Pathologic Results of True PN (n=37)

Pathology No. of patients (%)Multiple papillomas (MP)* 18 (48.6)Solitary papilloma (SP) † 11 (29.7)Papillary DCIS (pDCIS) 4 (10.8)Invasive papillary ca (IPCA) 4 (10.8)

* Including 5 cases of MP+other tumors; 2 atypical ductal hyperplasia (ADH) , 1 non pDCIS, mucinous ca, 1 invasive ductal ca(IDC) † Including 3 cases of SP+other tumors; 2 non pDCIS, 1 IDC

4. Pathologic Results of non PN (n=29)

0

5

10

15

20

25

malignant tumor* benign tumor†

No. of patients

5 (17.2%)24 (82.8%)

*15 IDC, 9 DCIS

† 3 fibroadenoma, 1 fibrocystic disease, 1 phyllodes tumor

5. Malignant Neoplasm

0

5

10

15

20

25

PN non PN

malignant benign

No. of patients

n=16

(43.2%)

n=21

(56.8%)

n=24

(82.2%)

n=5

(17.2%)

p=0.001

6. Radiologic Malignancy and PN

0

5

10

15

20

25

Radiologicmalignant

Radiologic benign

PN non PN

No. of patients

n=15

(42.9%)

n=20

(57.1%)

n=22

(71.0%)

n=9

(29.0%)

p=0.027

7. Radiologic Malignancy and Pathologic Malignancy

0

5

10

15

20

25

30

Radiologicmalignant

Radiologic benign

malignant benign

No. of patients

n=30

(85.7%)

n=5

(14.3%)

n=10

(32.3%)

n=21

(67.7%)

p<0.001

8. Cases of Radiologic Benign but Pathologic Malignant Tumors

No. of patients (%)DCIS 5 ( 50.0)IDC 3 ( 30.0)IPCA 2 ( 20.0)Total 10 (100.0)

An invasive papillary carcinoma (Lt) and a papilloma with clustered papillary architecture, which are difficult to differentiate malignancy

Conclusions

• When FNAB suggests ‘Papillary Neoplasm’, even if a radiologic benign, surgical excision should be considered because of high possibility of malignant tumor