Accuracy and Upgrading of CNB and BI-RADS Diagnoses Compared to Excision: A Clinicopathological-Radiological Correlation of Papillary Breast Lesions and Neoplasms

Document Type : Research Articles


1 Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

2 Faculty of Medicine, Horus University-Egypt, New Damietta, Egypt.

3 Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

4 Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Faculty of Medicine, Mansoura University, Mansoura, Egypt.

5 Medical Oncology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.


Background: Papillary breast lesions and neoplasms (PBLs/Ns) are diagnostically challenging lesions in both core needle biopsy (CNB) and radiology. Aim: To determine the accuracy and upgrade rate of CNB and BI-RADS diagnosis of PBLs/Ns compared to final excision diagnosis and the factors linked to upgrade. Methods: The favored CNB diagnosis and BI-RADS category for 82 PBLs/Ns were assessed based on histopathology, myoepithelial marker immunohistochemistry, mammographic/ultrasonographic findings. The radiological findings were compared to the pathological diagnoses. The accuracies of CNB and BI-RADS were compared to the excision diagnosis of the corresponding PBLs/Ns. The upgrade rates to malignancy were evaluated for both CNB and BI-RADS. Results: The presence of solid, irregular masses in breasts with composition A/B with calcification in radiology was significantly associated with the diagnosis of suspicious/malignant CNB, and malignant excision specimens (p<0.05). CNB was more accurate (90%), sensitive and specific with high positive and negative predictive values than BI-RADS. Combined CNB/BI-RADS accuracy was 90.2%. Overall upgrade rate came up to 9.8%. Upgrade rates to carcinoma were 7.3% for CNB and 8.5% for BI-RADS. Factors linked to upgrade were the age, lesion-size, BI-RADS category 4A and C, and histopathological/radiological discordance. All the upgraded PBLs/Ns were diagnosed as benign lesions in CNB with present/focally present myoepithelial diagnosis reflecting a sampling error. Conclusion: Up to 9.8% of PBLs/Ns diagnosed on CNB and BI-RADS undergo upgrading upon final excision, despite the high diagnostic accuracy. These evidences should be considered for final decision on whether to excise the lesion or not.


Main Subjects

Volume 23, Issue 11
November 2022
Pages 3959-3969
  • Receive Date: 13 June 2022
  • Revise Date: 19 September 2022
  • Accept Date: 26 November 2022
  • First Publish Date: 26 November 2022