Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors.

BACKGROUND: The clinical management of nonmalignant breast papillary lesions diagnosed at core-needle biopsy (CNB) is controversial. A meta-analysis was performed to evaluate pooled estimates of the underestimation of malignant papillary lesions (which were diagnosed as nonmalignant lesions at CNB) and to survey factors that affect that underestimation. METHODS: We searched for studies that provided data on CNB underestimates of malignant breast papillary lesions indexed in PUBMED. The pooled estimate for underestimation was calculated. The association between each variable and underestimation was investigated using either random- or fixed-effects logistic modeling. RESULTS: A total of 34 studies, which included 2,236 nonmalignant breast papillary lesions diagnosed at CNB and histologically examined after surgical excision, were included. Of these, 346 nonmalignant lesions at CNB were upgraded to malignant after surgical excision. The pooled estimate for the percentage of underestimation was 15.7% [95% confidence interval (CI): 12.8-18.5%]. The factors associated with higher underestimation included atypical papillary lesions (P<0.001), positive mammographic findings (P=0.022), and article publication year before 2005 (P<0.05). CONCLUSIONS: It is recommended that atypical papillary lesions at CNB undergo surgical excision, and it is reasonable to follow patients with benign lesions with serial imaging. Lesion type, mammographic findings, and article publication year were significantly associated with underestimation.