Archived Case 28

Surgical excision is recommended for all needle biopsy results that yield ADH. In about a third of cases, the pathology will be “upstaged” to DCIS when ADH is found at core biopsy. Thus needle sampling underestimates the true disease.

Repeat core biopsy will not avoid the need for surgical excision. ADH and DCIS are often not visible on MRI, and at this time are not in and of themselves indications for MRI.

Some centers perform excisional biopsy on all papillomas found at core biopsy in order to be sure a papillary carcinoma is not missed. However, some authors have reported that if the finding of a papilloma is concordant with the imaging findings, then a six month follow-up is recommended, as with any benign biopsy. Thus both of these answers (a and c) are correct.