MLLs are composed of mucin containing cysts which may rupture, with extravasation of mucin into surrounding stroma (Fig. 6).141 The imaging target may be indeterminate calcifications or a nodular mass. The epithelium lining the cysts of MLLs is often attenuated but may range from benign to ADH to DCIS.142 The reason management issues arise in this scenario are the concern as to whether there may be undersampling of areas of mucinous carcinoma. Of note, the presence of epithelial cells floating in pools of mucin may be attributable either to stripped epithelium from a benign MLL in a fragmented CNB specimen or to mucinous carcinoma. One small study reported that 30% of MLLs were found to be mucinous carcinoma on exision,143 though others have claimed that mucinous lesions can be accurately classified on the basis of the CNB.91,144 The largest study to date by Wang et al91 reviewed the CNB and surgical excision of 32 mucinous lesions, of which 29 diagnoses made on CNB were unchanged with excision. The remaining cases were diagnosed as MLL without atypia on CNB and only showed fibrocystic change on excision. In those cases that display disrupted mucin pools, the presence of capillaries within the mucinous stroma may offer a clue to the malignant nature of the lesion.145 Given the very small numbers in these studies, it is recommended that an excision to rule out mucinous DCIS or mucinous carcinoma be performed after the identification of MLL or stromal pools of mucin on CNB.
With the strong emphasis on radiologic-pathologic correlation when interpreting CNB specimens, it is important to keep in mind other entities that may form mass lesions aside from malignancy and those described above. Cysts, pseudoangiomatous stromal hyperplasia, fat necrosis and nodular adenosis can form a palpable mass or a mass lesion identified on imaging studies. Recognition of these lesions and their careful correlation with the imaging findings can prevent an unnecessary surgical excision. Table 5 summarized the non-malignant breast lesions for which excision is recommended.
In conclusion, when rendering an opinion on a CNB of the breast, the pathologist should always correlate the radiologic findings with those seen on the histologic sections and provide sufficient information to ensure the patient is triaged into the appropriate management pathway.
The authors wish to express their thanks to Dr Stuart Schnitt for reviewing and commenting on this manuscript during its preparation.
1. Dershaw DD, Liberman L. Stereotactic breast biopsy: indications and results. Oncology (Huntingt). 1998;12:907–922.
2. Meyer JE, Smith DN, Lester SC, et al. Large-core needle biopsy of nonpalpable breast lesions. JAMA. 1999;281:1638–1641.
3. Wong AY, Salisbury E, Bilous M. Recent developments in stereotactic breast biopsy methodologies: an update for the surgical pathologist. Adv Anat Pathol. 2000;7:26–35.
4. Liberman L. Centennial dissertation. Percutaneous imaging-guided core breast biopsy: state of the art at the millennium. AJR Am J Roentgenol. 2000;174:1191–1199.
5. Hoda SA, Rosen PP. Practical considerations in the pathologic diagnosis of needle core biopsies of breast. Am J Clin Pathol. 2002;118:101–108.
6. Liberman L, Goodstine SL, Dershaw DD, et al. One operation after percutaneous diagnosis of nonpalpable breast cancer: frequency and associated factors. AJR Am J Roentgenol. 2002;178:673–679.
7. Liberman L, Holland AE, Marjan D, et al. Underestimation of atypical ductal hyperplasia at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol. 2007;188:684–690.
8. Eby PR, Ochsner JE, DeMartini WB, et al. Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum-assisted breast biopsy: 9-versus 11-gauge. AJR Am J Roentgenol. 2009;192:229–234.
9. Brem RF, Behrndt VS, Sanow L, et al. Atypical ductal hyperplasia: histologic underestimation of carcinoma in tissue harvested from impalpable breast lesions using 11-gauge stereotactically guided directional vacuum-assisted biopsy. AJR Am J Roentgenol. 1999;172:1405–1407.
10. Perretta T, Pistolese CA, Bolacchi F, et al. MR imaging-guided 10-gauge vacuum-assisted breast biopsy: histological characterisation. Radiol Med. 2008;113:830–840.
11. Darling ML, Smith DN, Lester SC, et al. Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. AJR Am J Roentgenol. 2000;175:1341–1346.
12. Eby PR, Ochsner JE, DeMartini WB, et al. Is surgical excision necessary for focal atypical ductal hyperplasia found at stereotactic vacuum-assisted breast biopsy? Ann Surg Oncol. 2008;15:3232–3238.
13. Lourenco AP, Mainiero MB, Lazarus E, et al. Stereotactic breast biopsy: comparison of histologic underestimation rates with 11- and 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol. 2007;189:W275–W279.
14. Houssami N, Ciatto S, Ellis I, et al. Underestimation of malignancy of breast core-needle biopsy: concepts and precise overall and category-specific estimates. Cancer. 2007;109:487–495.
15. Jackman RJ, Nowels KW, Rodriguez-Soto J, et al. Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology. 1999;210:799–805.
16. Jacobs TW, Siziopikou KP, Prioleau JE, et al. Do prognostic marker studies on core needle biopsy specimens of breast carcinoma accurately reflect the marker status of the tumor? Mod Pathol. 1998;11:259–264.
17. Lerwill MF. Current practical applications of diagnostic immunohistochemistry in breast pathology. Am J Surg Pathol. 2004;28:1076–1091.
18. Chivukula M, Bhargava R, Brufsky A, et al. Clinical importance of HER2 immunohistologic heterogeneous expression in core-needle biopsies vs resection specimens for equivocal (immunohistochemical score 2+) cases. Mod Pathol. 2008;21:363–368.
19. Chivukula M, Haynik DM, Brufsky A, et al. Pleomorphic lobular carcinoma in situ (PLCIS) on breast core needle biopsies: clinical significance and immunoprofile. Am J Surg Pathol. 2008;32:1721–1726.
20. Sutela A, Vanninen R, Sudah M, et al. Surgical specimen can be replaced by core samples in assessment of ER, PR and HER-2 for invasive breast cancer. Acta Oncol. 2008;47:38–46.
21. Park SY, Kim KS, Lee TG, et al. The accuracy of preoperative core biopsy in determining histologic grade, hormone receptors, and human epidermal growth factor receptor 2 status in invasive breast cancer. Am J Surg. 2009;197:266–269.
22. Rakha EA, Ellis IO. An overview of assessment of prognostic and predictive factors in breast cancer needle core biopsy specimens. J Clin Pathol. 2007;60:1300–1306.
23. Collins LC, Connolly JL, Page DL, et al. Diagnostic agreement in the evaluation of image-guided breast core needle biopsies: results from a randomized clinical trial. Am J Surg Pathol. 2004;28:126–131.
24. Hoorntje LE, Schipper ME, Peeters PH, et al. The finding of invasive cancer after a preoperative diagnosis of ductal carcinoma-in-situ: causes of ductal carcinoma-in-situ underestimates with stereotactic 14-gauge needle biopsy. Ann Surg Oncol. 2003;10:748–753.
25. Balleyguier C, Ayadi S, Van Nguyen K, et al. BIRADS classification in mammography. Eur J Radiol. 2007;61:192–194.
26. Tse GM, Tan PH, Pang AL, et al. Calcification in breast lesions: pathologists' perspective. J Clin Pathol. 2008;61:145–151.
27. Tse GM, Tan PH, Cheung HS, et al. Intermediate to highly suspicious calcification in breast lesions: a radio-pathologic correlation. Breast Cancer Res Treat. 2008;110:1–7.
28. Berg WA, Arnoldus CL, Teferra E, et al. Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology. 2001;221:495–503.
29. Levy L, Suissa M, Chiche JF, et al. BIRADS ultrasonography. Eur J Radiol. 2007;61:202–211.
30. Agrawal G, Su MY, Nalcioglu O, et al. Significance of breast lesion descriptors in the ACR BI-RADS MRI lexicon. Cancer. 2009;115:1363–1380.
31. Tardivon AA, Athanasiou A, Thibault F, et al. Breast imaging and reporting data system (BIRADS): magnetic resonance imaging. Eur J Radiol. 2007;61:212–215.
32. Burbank F. Stereotactic breast biopsy: comparison of 14- and 11-gauge Mammotome probe performance and complication rates. Am Surg. 1997;63:988–995.
33. Liberman L, Cohen MA, Dershaw DD, et al. Atypical ductal hyperplasia diagnosed at stereotaxic core biopsy of breast lesions: an indication for surgical biopsy (see comments). AJR Am J Roentgenol. 1995;164:1111–1113.
34. Jackman RJ, Nowels KW, Shepard MJ, et al. Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia. Radiology. 1994;193:91–95.
35. Margolin FR, Kaufman L, Jacobs RP, et al. Stereotactic core breast biopsy of malignant calcifications: diagnostic yield of cores with and cores without calcifications on specimen radiographs. Radiology. 2004;233:251–254.
36. Burak WE Jr, Owens KE, Tighe MB, et al. Vacuum-assisted stereotactic breast biopsy: histologic underestimation of malignant lesions. Arch Surg. 2000;135:700–703.
37. Nath ME, Robinson TM, Tobon H, et al. Automated large-core needle biopsy of surgically removed breast lesions: comparison of samples obtained with 14-, 16-, and 18-gauge needles. Radiology. 1995;197:739–742.
38. Liberman L, Evans WP III, Dershaw DD, et al. Radiography of microcalcifications in stereotaxic mammary core biopsy specimens. Radiology. 1994;190:223–225.
39. Mainiero MB, Philpotts LE, Lee CH, et al. Stereotaxic core needle biopsy of breast microcalcifications: correlation of target accuracy and diagnosis with lesion size. Radiology. 1996;198:665–669.
40. Dahlstrom JE, Sutton S, Jain S. Histologic-radiologic correlation of mammographically detected microcalcification in stereotactic core biopsies. Am J Surg Pathol. 1998;22:256–259.
41. Dahlstrom JE, Jain S. Histological correlation of mammographically detected microcalcifications in stereotactic core biopsies. Pathology. 2001;33:444–448.
42. Liu X, Inciardi M, Bradley JP, et al. Microcalcifications of the breast: size matters! A mammographic-histologic correlation study. Pathologica. 2007;99:5–10.
43. D'Orsi CJ, Reale FR, Davis MA, et al. Breast specimen microcalcifications: radiographic validation and pathologic-radiologic correlation. Radiology. 1991;180:397–401.
44. Berg WA. When is core breast biopsy or fine-needle aspiration not enough? Radiology. 1996;198:313–315.
45. Rakha E, El-Sayad M, Reed J, et al. Screen-detected breast lesions with malignant needle core biopsy diagnoses and no malignancy identified in subsequent surgical excision specimens (potential false-positive diagnosis). Eur J Cancer. 2009; e-pub.
46. Reynolds HE. Core needle biopsy of challenging benign breast conditions: a comprehensive literature review. AJR Am J Roentgenol. 2000;174:1245–1250.
47. Jacobs TW, Connolly JL, Schnitt SJ. Non-malignant lesions in breast core needle biopsies: to excise or not to excise. Am J Surg Pathol. 2002;26:1095–1110.
48. Alonso-Bartolome P, Vega-Bolivar A, Torres-Tabanera M, et al. Sonographically guided 11-G directional vacuum-assisted breast biopsy as an alternative to surgical excision: utility and cost study in probably benign lesions. Acta Radiol. 2004;45:390–396.
49. Carder PJ, Khan T, Burrows P, et al. Large volume “mammotome” biopsy may reduce the need for diagnostic surgery in papillary lesions of the breast. J Clin Pathol. 2008;61:928–933.
50. Kim MJ, Kim EK, Lee JY, et al. Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings. Eur Radiol. 2007;17:2376–2383.
51. Povoski SP, Jimenez RE. A comprehensive evaluation of the 8-gauge vacuum-assisted Mammotome(R) system for ultrasound-guided diagnostic biopsy and selective excision of breast lesions. World J Surg Oncol. 2007;5:83.
52. Ferzli GS, Hurwitz JB. Initial experience with breast biopsy utilizing the advanced breast biopsy instrumentation (ABBI). Surg Endosc. 1997;11:393–396.
53. Damascelli B, Frigerio LF, Patelli G, et al. Stereotactic breast biopsy: en bloc excision of microcalcifications with a large-bore cannula device. AJR Am J Roentgenol. 1999;173:895–900.
54. Doridot V, Meunier M, El Khoury C, et al. Stereotactic radioguided surgery by SiteSelect for subclinical mammographic lesions. Ann Surg Oncol. 2005;12:181–188.
55. Corn CC. Review of 125 SiteSelect stereotactic large-core breast biopsy procedures. Breast J. 2003;9:147–152.
56. Kontos M, Felekouras E, Fentiman IS. Radiofrequency ablation in the treatment of primary breast cancer: no surgical redundancies yet. Int J Clin Pract. 2008;62:816–820.
57. Marcy PY, Magne N, Castadot P, et al. Ultrasound-guided percutaneous radiofrequency ablation in elderly breast cancer patients: preliminary institutional experience. Br J Radiol. 2007;80:267–273.
58. Van der Ploeg IM, Van Esser S, Van den Bosch MA, et al. Radiofrequency ablation for breast cancer: a review of the literature. Eur J Surg Oncol. 2007;33:673–677.
59. Tavassoli FA, Hoefler H, Rosai J, et al. Intraductal proliferative lesions. In: Tavassoli FA, Devilee P, eds. Pathology and Genetics: Tumours of the Breast and Female Genital Organs. Lyon: IARC Press; 2003:63–73.
60. Fraser JL, Raza S, Chorny K, et al. Columnar alteration with prominent apical snouts and secretions: a spectrum of changes frequently present in breast biopsies performed for microcalcifications. Am J Surg Pathol. 1998;22:1521–1527.
61. Abdel-Fatah TM, Powe DG, Hodi Z, et al. Morphologic and molecular evolutionary pathways of low nuclear grade invasive breast cancers and their putative precursor lesions: further evidence to support the concept of low nuclear grade breast neoplasia family. Am J Surg Pathol. 2008;32:513–523.
62. Goldstein NS, O'Malley BA. Cancerization of small ectatic ducts of the breast by ductal carcinoma in situ cells with apocrine snouts: a lesion associated with tubular carcinoma. Am J Clin Pathol. 1997;107:561–566.
63. Oyama T, Maluf H, Koerner F. Atypical cystic lobules: an early stage in the formation of low-grade ductal carcinoma in situ. Virchows Arch. 1999;435:413–421.
64. Rosen PP. Columnar cell hyperplasia is associated with lobular carcinoma in situ and tubular carcinoma. Am J Surg Pathol. 1999;23:1561.
65. De Mascarel I, MacGrogan G, Mathoulin-Pelissier S, et al. Epithelial atypia in biopsies performed for microcalcifications. Practical considerations about 2833 serially sectioned surgical biopsies with a long follow-up. Virchows Arch. 2007;451:1-10.
66. Sahoo S, Recant WM. Triad of columnar cell alteration, lobular carcinoma in situ, and tubular carcinoma of the breast. Breast J. 2005;11:140–142.
67. Brandt SM, Young GQ, Hoda SA. The “rosen triad”: tubular carcinoma, lobular carcinoma in situ, and columnar cell lesions. Adv Anat Pathol. 2008;15:140–146.
68. Harigopal MYD, Hoda SA, DeLellis RA, et al. Columnar cell alteration diagnosed on mammotome core biopsy for indeterminate microcalcifications: results of subsequent mammograms and surgical excision. Mod Pathol. 2002;15:36A.
69. Brogi E, Tan LK. Findings at excisional biopsy (EBX) performed after identification of columnar cell change (CCC) of ductal epithelium in breast core biopsy (CBX). Meeting abstract. Mod Pathol. 2002;15:29A–30A.
70. Kunju LP, Kleer CG. Significance of flat epithelial atypia on mammotome core needle biopsy: should it be excised? Hum Pathol. 2007;38:35–41.
71. Martel M, Barron-Rodriguez P, Tolgay Ocal I, et al. Flat DIN 1 (flat epithelial atypia) on core needle biopsy: 63 cases identified retrospectively among 1751 core biopsies performed over an 8-year period (1992–1999). Virchows Arch. 2007;451:883–891.
72. Pinder SE, Provenzano E, Reis-Filho JS. Lobular in situ neoplasia and columnar cell lesions: diagnosis in breast core biopsies and implications for management. Pathology. 2007;39:208–216.
73. Senetta R, Campanino PP, Mariscotti G, et al. Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations. Mod Pathol. 2009. Mar 13, e-pub.
74. Dahlstrom JE, Sutton S, Jain S. Histological precision of stereotactic core biopsy in diagnosis of malignant and premalignant breast lesions. Histopathology. 1996;28:537–541.
75. Moore MM, Hargett CW III, Hanks JB, et al. Association of breast cancer with the finding of atypical ductal hyperplasia at core breast biopsy. Ann Surg. 1997;225:726–731; discussion 731–733.
76. Liberman L, Smolkin JH, Dershaw DD, et al. Calcification retrieval at stereotactic, 11-gauge, directional, vacuum-assisted breast biopsy. Radiology. 1998;208:251–260.
77. Burbank F. Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted biopsy. Radiology. 1997;202:843–847.
78. Adrales G, Turk P, Wallace T, et al. Is surgical excision necessary for atypical ductal hyperplasia of the breast diagnosed by Mammotome? Am J Surg. 2000;180:313–315.
79. Ely KA, Carter BA, Jensen RA, et al. Core biopsy of the breast with atypical ductal hyperplasia: a probabilistic approach to reporting. Am J Surg Pathol. 2001;25:1017–1021.
80. Sneige N, Lim SC, Whitman GJ, et al. Atypical ductal hyperplasia diagnosis by directional vacuum-assisted stereotactic biopsy of breast microcalcifications. Considerations for surgical excision. Am J Clin Pathol. 2003;119:248–253.
81. Wagoner MJ, Laronga C, Acs G. Extent and histologic pattern of atypical ductal hyperplasia present on core needle biopsy specimens of the breast can predict ductal carcinoma in situ in subsequent excision. Am J Clin Pathol. 2009;131:112–121.
82. Hoang JK, Hill P, Cawson JN. Can mammographic findings help discriminate between atypical ductal hyperplasia and ductal carcinoma in situ after needle core biopsy? Breast. 2008;17:282–288.
83. Forgeard C, Benchaib M, Guerin N, et al. Is surgical biopsy mandatory in case of atypical ductal hyperplasia on 11-gauge core needle biopsy? A retrospective study of 300 patients. Am J Surg. 2008;196:339–345.
84. Dillon MF, McDermott EW, Quinn CM, et al. Predictors of invasive disease in breast cancer when core biopsy demonstrates DCIS only. J Surg Oncol. 2006;93:559–563.
85. Doyle B, Al-Mudhaffer M, Kennedy MM, et al. Sentinel lymph node biopsy in patients with a needle core biopsy diagnosis of DCIS—is it justified? J Clin Pathol. 2009. Mar 18, e-pub.
86. Farkas EA, Stolier AJ, Teng SC, et al. An argument against routine sentinel node mapping for DCIS. Am Surg. 2004;70:13–17; discussion 17-8.
87. Goyal A, Douglas-Jones A, Monypenny I, et al. Is there a role of sentinel lymph node biopsy in ductal carcinoma in situ? Analysis of 587 cases. Breast Cancer Res Treat. 2006;98:311–314.
88. Jackman RJ, Burbank F, Parker SH, et al. Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology. 2001;218:497–502.
89. Lee CH, Carter D, Philpotts LE, et al. Ductal carcinoma in situ diagnosed with stereotactic core needle biopsy: can invasion be predicted? Radiology. 2000;217:466–470.
90. Mittendorf EA, Arciero CA, Gutchell V, et al. Core biopsy diagnosis of ductal carcinoma in situ: an indication for sentinel lymph node biopsy. Curr Surg. 2005;62:253–257.
91. Wang J, Simsir A, Mercado C, et al. Can core biopsy reliably diagnose mucinous lesions of the breast? Am J Clin Pathol. 2007;127:124–127.
92. Wilkie C, White L, Dupont E, et al. An update of sentinel lymph node mapping in patients with ductal carcinoma in situ. Am J Surg. 2005;190:563–566.
93. Yen TW, Hunt KK, Ross MI, et al. Predictors of invasive breast cancer in patients with an initial diagnosis of ductal carcinoma in situ: a guide to selective use of sentinel lymph node biopsy in management of ductal carcinoma in situ. J Am Coll Surg. 2005;200:516–526.
94. Estourgie SH, Valdes Olmos RA, Nieweg OE, et al. Excision biopsy of breast lesions changes the pattern of lymphatic drainage. Br J Surg. 2007;94:1088–1091.
95. Feldman SM, Krag DN, McNally RK, et al. Limitation in gamma probe localization of the sentinel node in breast cancer patients with large excisional biopsy. J Am Coll Surg. 1999;188:248–254.
96. Huo L, Sneige N, Hunt KK, et al. Predictors of invasion in patients with core-needle biopsy-diagnosed ductal carcinoma in situ and recommendations for a selective approach to sentinel lymph node biopsy in ductal carcinoma in situ. Cancer. 2006;107:1760–1768.
97. Renshaw AA. Predicting invasion in the excision specimen from breast core needle biopsy specimens with only ductal carcinoma in situ. Arch Pathol Lab Med. 2002;126:39–41.
98. Dillon MF, Maguire AA, McDermott EW, et al. Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery. Mod Pathol. 2008;21:39–45.
99. Cangiarella J, Guth A, Axelrod D, et al. Is surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy? A report of 38 cases and review of the literature. Arch Pathol Lab Med. 2008;132:979–983.
100. Elsheikh TM, Silverman JF. Follow-up surgical excision is indicated when breast core needle biopsies show atypical lobular hyperplasia or lobular carcinoma in situ: a correlative study of 33 patients with review of the literature. Am J Surg Pathol. 2005;29:534–543.
101. Brem RF, Lechner MC, Jackman RJ, et al. Lobular neoplasia at percutaneous breast biopsy: variables associated with carcinoma at surgical excision. AJR Am J Roentgenol. 2008;190:637–641.
102. Nagi CS, O'Donnell JE, Tismenetsky M, et al. Lobular neoplasia on core needle biopsy does not require excision. Cancer. 2008;112:2152–2158.
103. Liberman L, Sama M, Susnik B, et al. Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings. AJR Am J Roentgenol. 1999;173:291–299.
104. Menon S, Porter GJ, Evans AJ, et al. The significance of lobular neoplasia on needle core biopsy of the breast. Virchows Arch. 2008;452:473–479.
105. Jacobs TW, Pliss N, Kouria G, et al. Carcinomas in situ of the breast with indeterminate features: role of E-cadherin staining in categorization. Am J Surg Pathol. 2001;25:229–236.
106. Sneige N, Wang J, Baker BA, et al. Clinical, histopathologic, and biologic features of pleomorphic lobular (ductal-lobular) carcinoma in situ of the breast: a report of 24 cases. Mod Pathol. 2002;15:1044–1050.
107. Hanby AM, Hughes TA. In situ and invasive lobular neoplasia of the breast. Histopathology. 2008;52:58–66.
108. Tan PH, Aw MY, Yip G, et al. Cytokeratins in papillary lesions of the breast: is there a role in distinguishing intraductal papilloma from papillary ductal carcinoma in situ? Am J Surg Pathol. 2005;29:625–632.
109. Tse GM, Tan PH, Moriya T. The role of immunohistochemistry in the differential diagnosis of papillary lesions of the breast. J Clin Pathol. 2009;62:407–413.
110. Mulligan AM, O'Malley FP. Papillary lesions of the breast: a review. Adv Anat Pathol. 2007;14:108–119.
111. Page DL, Salhany KE, Jensen RA, et al. Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer. 1996;78:258–266.
112. MacGrogan G, Tavassoli FA. Central atypical papillomas of the breast: a clinicopathological study of 119 cases. Virchows Arch. 2003;443:609–617.
113. Renshaw AA, Derhagopian RP, Tizol-Blanco DM, et al. Papillomas and atypical papillomas in breast core needle biopsy specimens: risk of carcinoma in subsequent excision. Am J Clin Pathol. 2004;122:217–221.
114. Ivan D, Selinko V, Sahin AA, et al. Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy. Mod Pathol. 2004;17:165–171.
115. Carder PJ, Garvican J, Haigh I, et al. Needle core biopsy can reliably distinguish between benign and malignant papillary lesions of the breast. Histopathology. 2005;46:320–327.
116. Ioffe OB, Berg WA, Silverberg SG, et al. Analysis of papillary lesions diagnosed on core needle biopsy of the breast: management implications (Meeting Abstract). Mod Pathol. 2000;13:23A.
117. Skandarajah AR, Field L, Yuen Larn Mou A, et al. Benign papilloma on core biopsy requires surgical excision. Ann Surg Oncol. 2008;15:2272–2277.
118. Mercado CL, Hamele-Bena D, Oken SM, et al. Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology. 2006;238:801–808.
119. Kil WH, Cho EY, Kim JH, et al. Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy? Breast. 2008;17:258–262.
120. Rizzo M, Lund MJ, Oprea G, et al. Surgical follow-up and clinical presentation of 142 breast papillary lesions diagnosed by ultrasound-guided core-needle biopsy. Ann Surg Oncol. 2008;15:1040–1047.
121. Tseng HS, Chen YL, Chen ST, et al. The management of papillary lesion of the breast by core needle biopsy. Eur J Surg Oncol. 2009;35:21–24.
122. Bernik SF, Troob S, Ying BL, et al. Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up. Am J Surg. 2009;197:473–478.
123. Sydnor MK, Wilson JD, Hijaz TA, et al. Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy. Radiology. 2007;242:58–62.
124. Brenner RJ, Jackman RJ, Parker SH, et al. Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR Am J Roentgenol. 2002;179:1179–1184.
125. Brodie C, O'Doherty A, Quinn C. Fourteen-gauge needle core biopsy of mammographically evident radial scars: is excision necessary? Cancer. 2004;100:652–663; author reply 653-4.
126. Cawson JN, Malara F, Kavanagh A, et al. Fourteen-gauge needle core biopsy of mammographically evident radial scars: is excision necessary? Cancer. 2003;97:345–351.
127. Douglas-Jones AG, Denson JL, Cox AC, et al. Radial scar lesions of the breast diagnosed by needle core biopsy: analysis of cases containing occult malignancy. J Clin Pathol. 2007;60:295–298.
128. Doyle EM, Banville N, Quinn CM, et al. Radial scars/complex sclerosing lesions and malignancy in a screening programme: incidence and histological features revisited. Histopathology. 2007;50:607–614.
129. Kirwan SE, Denton ER, Nash RM, et al. Multiple 14G stereotactic core biopsies in the diagnosis of mammographically detected stellate lesions of the breast. Clin Radiol. 2000;55:763–766.
130. Philpotts LE, Shaheen NA, Jain KS, et al. Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology. 2000;216:831–837.
131. Sloane JP, Mayers MM. Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age. Histopathology. 1993;23:225–231.
132. Resetkova E, Edelweiss M, Albarracin CT, et al. Management of radial sclerosing lesions of the breast diagnosed using percutaneous vacuum-assisted core needle biopsy: recommendations for excision based on seven years' of experience at a single institution. Breast Cancer Res Treat. 2008. Jul 15, e-pub.
133. Becker L, Trop I, David J, et al. Management of radial scars found at percutaneous breast biopsy. Can Assoc Radiol J. 2006;57:72–78.
134. Jacobs TW, Chen YY, Guinee DG Jr, et al. Fibroepithelial lesions with cellular stroma on breast core needle biopsy: are there predictors of outcome on surgical excision? Am J Clin Pathol. 2005;124:342–354.
135. Lee AH, Hodi Z, Ellis IO, et al. Histological features useful in the distinction of phyllodes tumour and fibroadenoma on needle core biopsy of the breast. Histopathology. 2007;51:336–344.
136. Dershaw DD, Morris EA, Liberman L, et al. Nondiagnostic stereotaxic core breast biopsy: results of rebiopsy. Radiology. 1996;198:323–325.
137. Ioffe OB, Berg WA, Silverberg SG, et al. Mammographic-histopathologic correlation of large-core needle biopsies of the breast. Mod Pathol. 1998;11:721–727.
138. Meyer JE, Smith DN, Lester SC, et al. Large-needle core biopsy: nonmalignant breast abnormalities evaluated with surgical excision or repeat core biopsy. Radiology. 1998;206:717–720.
139. Komenaka IK, El-Tamer M, Pile-Spellman E, et al. Core needle biopsy as a diagnostic tool to differentiate phyllodes tumor from fibroadenoma. Arch Surg. 2003;138:987–990.
140. Dupont WD, Page DL, Parl FF, et al. Long-term risk of breast cancer in women with fibroadenoma. N Engl J Med. 1994;331:10–15.
141. Rosen PP. Breast Pathology. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:522.
142. Ro JY, Sneige N, Sahin AA, et al. Mucocele-like tumor of the breast associated with atypical ductal hyperplasia or mucinous carcinoma. A clinicopathologic study of seven cases. Arch Pathol Lab Med. 1991;115:137–140.
143. Carder PJ, Murphy CE, Liston JC. Surgical excision is warranted following a core biopsy diagnosis of mucocoele-like lesion of the breast. Histopathology. 2004;45:148–154.
144. Renshaw AA. Can mucinous lesions of the breast be reliably diagnosed by core needle biopsy? Am J Clin Pathol. 2002;118:82–84.
145. Gadre SA, Perkins GH, Sahin AA, et al. Neovascularization in mucinous ductal carcinoma in situ suggests an alternative pathway for invasion. Histopathology. 2008;53:545–553.