1. Breast Tumors Diagnosed as Papillary Neoplasm by FNAB Dae-Kyum Kim, Sang-Uk Woo, Jeong-Han Kim, Seok-Jin Nam, Yoon-La Choi 1, Young-Lyun Oh 1 and Jung-Hyun Yang Department of Surgery and 1 Pathology, Samsung Medical Center, Sungkyunkwan University, School of Medicine

2. Introduction Papillary neoplasm (PN) of the breast Fine Needle Aspiration Biosy (FNAB)

3. 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)

4. 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 malignancy Radiologic benign; BIRAD 1~3 Radiologic malignant; BIRAD 4~5 Statistics t test Chi-square or Fisher’s exact test

5. Results 1.Pathologic results for PN on FNAB No. of patients n=37 (56.1%) n=29 (43.9%)

6. 2. Tumor Size Size (cm) 1.5cm2.8cm P=0.001 Mean size= 2.1 cm

7. 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

8. 4. Pathologic Results of non PN (n=29) No. of patients 5 (17.2%)24 (82.8%) *15 IDC, 9 DCIS † 3 fibroadenoma, 1 fibrocystic disease, 1 phyllodes tumor

9. 5. Malignant Neoplasm No. of patients n=16 (43.2%) n=21 (56.8%) n=24 (82.2%) n=5 (17.2%) p=0.001

10. 6. Radiologic Malignancy and PN No. of patients n=15 (42.9%) n=20 (57.1%) n=22 (71.0%) n=9 (29.0%) p=0.027

11. 7. Radiologic Malignancy and Pathologic Malignancy No. of patients n=30 (85.7%) n=5 (14.3%) n=10 (32.3%) n=21 (67.7%) p<0.001

12. 8. Cases of Radiologic Benign but Pathologic Malignant Tumors No. of patients (%) DCIS 5 ( 50.0) IDC 3 ( 30.0) IPCA 2 ( 20.0) Total10 (100.0)

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

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