Case 56 Answer 2

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.

To review a similar case see below.

What about the papilloma?  When a papilloma is found at core biopsy, what is your recommendation?

• 6 month follow-up if this pathology is concordant with imaging findings
• Repeat core biopsy if this is discordant
• Surgical excision in all cases