High upgrade rate to invasive carcinoma makes subclassification of papillary carcinoma of the breast in core needle biopsy unnecessary

Aims Papillary carcinoma diagnosed in core needle biopsy (CNB) refers to carcinoma with papillary features but no definitive invasion, including papillary ductal carcinoma in situ (DCIS), papilloma with DCIS, encapsulated papillary carcinoma (EPC) and solid papillary carcinoma (SPC). This study assesses the upgrade rate of papillary carcinoma in CNB and supports the use of 'papillary carcinoma' as an umbrella term. Methods A retrospective review identified 41 CNB cases of non-invasive papillary carcinoma with subsequent excision (2011-2018). H&E and immunohistochemistry slides from CNBs were reviewed, and excisional diagnoses were retrieved. Results All 41 CNB cases were either DCIS or upgraded to invasive carcinoma upon excision, with an overall upgrade rate to invasive carcinoma of 39% (16/41). Subtypes showed varying upgrade rates: 16.7% (1/6) for papillary DCIS, 25% (1/4) for papilloma with DCIS, 83.3% (5/6) for SPC, 100% (1/1) for EPC and 33.3% (8/24) for unclassifiable papillary carcinoma. No lymph node metastases, recurrences or breast cancer-related mortality were observed during the follow-up period. Conclusions Given the high upgrade rate, subclassification of papillary carcinoma in CNB lacks clinical significance. The term 'papillary carcinoma' should be used in CNB, and lymph node removal warrants further investigation.