Invest Clin 67(2): 289 - 299, 2026 https://doi.org/10.54817/IC.v67n2a10

Corresponding author: Tuba Devrim, Yeni Mahalle, 8780/1 Sk 18, 35620 Cigli/Izmir, Turkiye.

Phone +905432022088. Email: tuba.devrim@bakircay.edu.tr

Breast papillary lesions: comparative

analysis of core needle biopsy and surgical

excision findings in a single-center

retrospective cohort with literature review.

Tuba Devrim1, Gamze Erkılınç1, Saniye Sevim Tuncer2, Şaziye Ceren Pehlivan1,

Fazilet Uğur Duman2 and Eyup Kebapci3

1Izmir Bakircay University, Çiğli Training and Research Hospital, Department of Medical

Pathology, Izmir, Turkey.

2 Ministry of Health, Çiğli Training and Research Hospital, Department of Medical

Pathology, Izmir, Turkey.

3Izmir Bakircay University, Çiğli Training and Research Hospital, Department of General

Surgery, Izmir, Turkey.

Keywords: Papillary breast lesion; Core needle biopsy; Myoepithelial cell; Estrogen

receptor; Excision.

Abstract. This retrospective study aimed to identify histopathological and

immunohistochemical predictors of malignancy requiring surgical excision

among papillary breast lesions diagnosed by core-needle biopsy (CNB). Fifty-

three women with CNB-diagnosed papillary breast lesions who subsequently

underwent surgical excision at the İzmir Bakırçay University Çiğli Hospital be-

tween January 2015 and January 2025 were included. Clinical, radiological,

and pathological data were analyzed. Twenty-eight patients (52.8%) were ≤50

years of age, and 21 lesions (39.6%) were larger than 3 cm. Surgical excision

revealed benign lesions in 24 cases, malignant lesions in 16 cases, and intracys-

tic solid carcinoma or atypical ductal hyperplasia in 13 cases. The malignancy/

atypia group (45.2%) showed a significantly higher frequency of myoepithelial

cell loss (p<0.001) and microcalcifications (p=0.028), and uniform, strong es-

trogen receptor positivity (100%) on CNB. Benign lesions were more commonly

peripherally located (p=0.049). No significant associations were observed with

age, Breast Imaging Reporting and Data System (BI-RADS) category, or lesion

size. These findings indicate that loss of myoepithelial cells and estrogen re-

ceptor positivity are strong predictors of malignancy and support the routine

incorporation of immunohistochemical evaluation into CNB-based risk strati-

fication.

290 Devrim et al.

Investigación Clínica 67(2): 2026

Lesiones papilares mamarias: análisis comparativo

de los hallazgos de la biopsia con aguja gruesa y de la escisión

quirúrgica en una cohorte retrospectiva de un solo centro,

con revisión de la literatura.

Invest Clin 2026; 67 (2): 289 – 299

Palabras clave: Lesión papilar mamaria; Biopsia con aguja gruesa; Célula mioepitelial;

Receptor de estrógeno; Escisión.

Resumen. Este estudio retrospectivo tuvo como objetivo identificar predic-

tores histopatológicos e inmunohistoquímicos de malignidad que requieren esci-

sión quirúrgica en lesiones papilares mamarias diagnosticadas mediante biopsia

con aguja gruesa (BAG). Se incluyó a un total de 53 mujeres diagnosticadas

con lesiones papilares mamarias por BAG que posteriormente fueron sometidas

a escisión quirúrgica en el Hospital Çiğli de la Universidad de İzmir Bakırçay

entre enero de 2015 y enero de 2025. Se analizaron datos clínicos, radiológi-

cos y patológicos. Veintiocho pacientes (52,8%) tenían ≤50 años y 21 lesiones

(39,6%) tenían un tamaño mayor a 3 cm. La escisión quirúrgica reveló lesiones

benignas en 24 casos, lesiones malignas en 16 y carcinoma sólido intraquístico/

hiperplasia ductal atípica en 13 casos. El grupo con malignidad/atipia (45,2%)

presentó una frecuencia significativamente mayor de pérdida de células mioepi-

teliales (p<0,001) y de microcalcificaciones (p = 0,028), así como una positi-

vidad uniforme y fuerte para el receptor de estrógeno (100%) en la BAG. Las

lesiones benignas se localizaron con mayor frecuencia en la periferia (p = 0,049).

No se observaron asociaciones significativas con la edad, la categoría Sistema

de Informes y Registro de Datos de Imagen de la Mama (BI-RADS) ni el tamaño

de la lesión. Estos hallazgos indican que la pérdida de células mioepiteliales y la

positividad para el receptor de estrógeno son predictores sólidos de malignidad y

respaldan la incorporación sistemática de la evaluación inmunohistoquímica en

la estratificación del riesgo basada en la BAG.

Received: 09-02-2026 Accepted: 21-04-2026

INTRODUCTION

Breast papillary lesions encompass a

broad spectrum of entities characterized by

a papillary architecture with arborizing fi-

brovascular cores. These lesions range from

benign intraductal papillomas to atypical

papillary proliferations and overt papillary

carcinomas. Clinical examination and imag-

ing modalities lack sufficient specificity to

reliably distinguish among these entities,

making histopathologic evaluation essential

for accurate diagnosis. Classification is pri-

marily based on the nature of the proliferat-

ing epithelial component and the presence

or absence of a basal myoepithelial cell layer,

which is a critical discriminator among be-

nign, in situ, and invasive lesions.

Benign papillary lesions include intra-

ductal papillomas, which may be associated

with epithelial hyperplasia, metaplasia, atyp-

ical ductal hyperplasia, or ductal carcinoma

in situ (DCIS). Malignant papillary neo-

plasms include papillary DCIS, encapsulat-

ed papillary carcinoma, solid papillary car-

cinoma (in situ and invasive), and invasive

Core needle biopsy versus excision in papillary breast lesions 291

Vol. 67(2): 289 - 299, 2026

papillary carcinoma. Despite this structured

categorization, these lesions often show

overlapping morphological and immuno-

histochemical features, posing substantial

diagnostic challenges, particularly with lim-

ited tissue samples obtained by core-needle

biopsy (CNB). In this setting, underdiagno-

sis is more common than overdiagnosis, es-

pecially when invasive components are focal

or discontinuous 1.

Papillary neoplasms account for ap-

proximately 5% of all breast biopsies. How-

ever, their detection rate has risen in recent

years, largely due to advances in image-guid-

ed percutaneous biopsy techniques and the

widespread use of high-resolution breast ul-

trasonography 2. According to the 5th edi-

tion of the WHO Classification of Breast

Tumors, papillary neoplasms are classified

into five major groups: intraductal papillo-

ma, papillary DCIS, encapsulated papillary

carcinoma, solid papillary carcinoma, and

invasive papillary carcinoma. Although uni-

fied by their characteristic papillary archi-

tecture, these lesions exhibit considerable

morphological, immunohistochemical, and

biological heterogeneity, reflecting a con-

tinuum from benign to malignant disease 2-4.

Accurate distinction between noninva-

sive and invasive papillary carcinomas is crit-

ical for prognostic assessment and therapeu-

tic planning. Histologic features supporting

invasion include irregular clusters, tongues,

and nests of tumor cells that extend into the

surrounding stroma beyond a well-defined

boundary. Nevertheless, limited sampling,

tissue fragmentation, and artifactual distor-

tion in CNB specimens often complicate this

distinction, even when myoepithelial immu-

nohistochemical markers 5, 6 are used.

At the molecular level, papillary car-

cinomas predominantly align with luminal

breast cancer subtypes, consistent with their

generally low-grade biology and favorable

clinical behavior 1. Papillary carcinoma of

the breast is a distinct, relatively uncommon

subtype that occurs predominantly in post-

menopausal women and accounts for a small

proportion of all breast malignancies. Histo-

logically, it is characterized by well-formed

papillary structures lined by multilayered or

pseudostratified neoplastic epithelial cells,

supported by delicate fibrovascular cores 7.

Importantly, neither encapsulated papillary

carcinoma nor solid papillary carcinoma

with associated invasive foci should be clas-

sified as invasive papillary carcinoma, as true

invasive papillary carcinoma is a separate,

rare entity with an excellent prognosis, low

recurrence rates, and prolonged disease-free

survival 8.

Preoperative CNB is widely regarded as

the standard diagnostic modality for evalu-

ating breast lesions. However, discrepancies

between CNB diagnoses and subsequent

surgical excision specimens remain incom-

pletely characterized, and the overall degree

of diagnostic concordance between these

modalities has not been fully elucidated 9. As

reliance on CNB has increased, management

strategies for benign intraductal papillomas

without atypia have shifted toward more

conservative, surveillance-based approaches

rather than routine surgical excision 10. Nev-

ertheless, papillary lesions remain among

the most diagnostically challenging entities

in breast pathology.

Given these challenges, identifying

reliable histopathological and immunohis-

tochemical predictors of malignancy risk

in papillary lesions diagnosed by CNB is of

substantial clinical importance. The present

study aims to contribute to this ongoing ef-

fort by evaluating key diagnostic parameters

that may help stratify malignancy risk and

guide decisions regarding the necessity of

surgical excision.

PATIENTS AND METHODS

Study design

Between January 2015 and January

2025, 53 female patients who received a his-

topathological diagnosis of papillary breast

lesions on CNB in the Department of Medi-

cal Pathology at İzmir Bakırçay University

292 Devrim et al.

Investigación Clínica 67(2): 2026

Çiğli Training and Research Hospital and

subsequently underwent surgical excision

at the same institution were enrolled in this

retrospective study. Cases were identified

through a systematic search of the institu-

tional pathology database. Ethics committee

approval for this study was obtained from the

İzmir Bakırçay University Non-Intervention-

al Clinical Research Ethics Committee on 03

July 2024 (decision no. 1657).

Clinical, radiological, and pathological

data were extracted from the electronic hos-

pital information system. Collected variables

included patient age at diagnosis, radiologi-

cally measured lesion size, anatomical local-

ization within the breast parenchyma, and

the Breast Imaging Reporting and Data Sys-

tem (BI-RADS) score assigned at the time of

diagnostic imaging.

Histopathological evaluation of excision

and CNB specimens included assessment of

papillary architecture, the presence or ab-

sence of an intact myoepithelial cell layer,

and any associated atypical or malignant

epithelial proliferations. Myoepithelial cell

status was determined by routine hematoxy-

lin–eosin (H&E) staining, supplemented,

when necessary, with immunohistochemi-

cal markers such as p63, CK5/6, or smooth

muscle myosin heavy chain. Estrogen recep-

tor (ER) expression was evaluated immuno-

histochemically in accordance with current

ASCO/CAP guidelines and recorded semi-

quantitatively. All microscopic assessments

were performed by at least two experienced

breast pathologists.

Histopathologic evaluation was per-

formed on tissue obtained via CNB. Tumors

were classified by neoplastic nature, archi-

tectural features, and cytomorphologic char-

acteristics. Biopsy sites were selected based

on radiologic assessment, targeting lesions

with high BI-RADS categories or clinically

palpable abnormalities. CNB was the pri-

mary diagnostic procedure, with sampling

directed toward the most suspicious radio-

logic or clinical regions.

Immunohistochemical (IHC) analysis

was performed to assess estrogen receptor

(ER), progesterone receptor (PR), and hu-

man epidermal growth factor receptor 2

(HER2) expression. ER and PR positivity

was defined as nuclear staining in ≥1% of

tumor cells. HER2 status was interpreted us-

ing standard scoring criteria (0 to 3+), with

equivocal (2+) cases further evaluated by

fluorescence in situ hybridization (FISH).

Statistical analysis

Statistical analyses were conducted us-

ing SPSS (version 22.0; IBM Corp., Armonk,

NY, USA). Continuous variables were tested

for normality using the Kolmogorov–Smirnov

test. Descriptive statistics were reported as

mean ± standard deviation (SD) or median

(interquartile range, IQR) for continuous

variables, and as frequencies and percent-

ages for categorical variables.

Comparisons among diagnostic groups

(benign, in situ/atypical, and malignant)

were conducted using the Chi-square test or

Fisher’s exact test for categorical variables

and the Student’s t-test or Mann–Whitney U

test for continuous variables, based on dis-

tributional characteristics. For multigroup

comparisons, one-way ANOVA or the Krus-

kal–Wallis test was applied as appropriate.

The association between histopatholog-

ical parameters (e.g., myoepithelial cell loss,

ER expression), radiologic features, and fi-

nal excision outcomes was examined using

binary logistic regression to identify inde-

pendent predictors of atypia or malignancy.

A p-value <0.05 was considered statistically

significant.

RESULTS

Among the 53 patients analyzed, 28

(52.8%) were ≤50 years of age, and lesions

>3 cm were identified in 21 cases (39.6%).

Based on excision pathology, patients were

classified into benign (n = 24), malignant

(n = 16), and in situ carcinoma (ISC)/

Core needle biopsy versus excision in papillary breast lesions 293

Vol. 67(2): 289 - 299, 2026

atypical ductal hyperplasia (ADH) (n = 13)

groups. CNB results were classified into be-

nign, borderline/atypical, and malignant

categories, and then compared with the fi-

nal excision diagnoses. This comparison al-

lowed evaluation of diagnostic concordance

and identification of underestimation or

upgrade rates between biopsy and excision

specimens. The grouped distribution of

CNB diagnoses and their corresponding ex-

cision pathology outcomes is summarized

in Table 1. A total of 53 cases were evalu-

ated, and excision outcomes were analyzed

in relation to their corresponding BI-RADS

assessments to determine the association

between radiological classification and fi-

nal pathological diagnosis. The distribution

of excision pathology results according to

BI-RADS categories is presented in Table 2.

Representative histopathological an d im-

munohistochemical features of DCIS with

papillary features (Fig. 1), encapsulated

papillary carcinoma (Fig. 2), and invasive

encapsulated papillary carcinoma (Fig. 3)

are shown.

Lesions with atypia or malignancy

(combined ISC/ADH and malignant co-

hort; 45.2%) had a markedly higher rate of

myoepithelial cell loss than benign lesions

(p<0.001). Within this cohort, 20.7% of le-

sions exceeded 3 cm. The atypical group had

a significantly higher frequency of microcal-

cifications (p = 0.028), and all cases (100%)

showed strong ER immunoreactivity on CNB

specimens, indicating uniform hormone re-

ceptor positivity.

Table 1. Distribution of core needle biopsy diagnoses and corresponding excision outcomes.

Tru-Cut Biopsi

Diagnostic Group

Tru-Cut Biopsi Specific BX

Diagnosis

Corresponding Excision Outcome(s) n

Benign Papillary

Lesions

IDP IDP, ADH+IDP, FCD, Fibroadenoma,

DCIS, Invasive EPC, NSTIC (rare upgrades)

USD–associated papilloma IDP 1

Micropapilloma FCD, FCD+fibroadenoma 2

Atypical Papillary

Lesions

ADH UDH/FCD, IDP 4

Papillary neoplasia

(atypia not excluded)

DCIS, DCIS+IDP, Sclerosing

papilloma, NSTIC, EPC

In situ Malignant

Lesions

DCIS DCIS, DCIS+IDP, SPC, NSTIC 5

DCIS + EPC EPC 1

DCIS + IDP DCIS+IDP 1

Encapsulated /

Papillary Carcinoma

Spectrum

EPC ± invasive component EPC, invasive EPC, invasive

papillary carcinoma

SPC SPC 1

Invasive

Carcinomas

NSTIC with EPC Invasive EPC 1

Invasive mucinous carcinoma

with papillary component

Mucinous carcinoma

Invasive papillary carcinoma Invasive papillary carcinoma 1

Other Papillary/

Proliferative

Lesions

Ductal hyperplasia with

papillary structures

DCIS 1

IDP: Intraductal papilloma; ADH: Atypical ductal hyperplasia; FCD: Fibrocystic disease; NSTIC: Invasive carcinoma,

no special type; EPC: Encapsulated papillary carcinoma; DCIS: Ductal carcinoma in situ; UDH: Usual ductal hyper-

plasia; SPC: Solid papillary carcinoma.

294 Devrim et al.

Investigación Clínica 67(2): 2026

Benign lesions were significantly more

likely to be peripherally localized than atypi-

cal lesions (p = 0.049). No statistically sig-

nificant intergroup differences were observed

in age distribution, BI-RADS category, lesion

size, or other parameters (all p>0.05).

Table 2. BI-RADS-based distribution

of excision results (n = 53).

BI-RADS Benign Malign Total

2 5 1 6

3 6 8 14

4 14 16 30

5 2 1 3

Breast Imaging Reporting and Data System (BI-RADS).

Fig. 1. Histopathological and immunohistochemical findings in a case of ductal carcinoma in situ with papi-

llary features. A: A case diagnosed as grade 2 ductal carcinoma in situ on excisional biopsy; the Tru-

Cut biopsy section primarily demonstrates papillary neoplasia in situ, stained with hematoxylin and

eosin (×40); B, C, D: Immunohistochemical staining with p63 (B), CK5/6 (C), and smooth muscle

myosin (D) demonstrating the presence of the myoepithelial layer (×40); E: Immunohistochemical

staining for estrogen receptor (ER) showing 30% nuclear positivity (×40); F: Ki-67 immunohistoche-

mical staining demonstrating a proliferative index of 10% (×40).

Core needle biopsy versus excision in papillary breast lesions 295

Vol. 67(2): 289 - 299, 2026

DISCUSSION

Papillary breast lesions constitute a

diagnostically heterogeneous group, rang-

ing from benign intraductal papillomas to

atypical papillary proliferations and papil-

lary carcinomas. Because of their complex

architectural patterns and frequent histo-

logic overlap, accurate classification based

solely on CNB specimens remains challeng-

ing. Although CNB is widely accepted as a

minimally invasive and effective initial di-

agnostic tool, its inherent sampling limita-

tions may lead to underestimating atypia or

malignancy in papillary lesions, particularly

in those with focal or heterogeneous atypical

components 11.

Although papillary breast lesions share

a characteristic papillary architecture, they

display a broad spectrum of morphologi-

cal, immunohistochemical, and biological

features 3,12. Ongoing advances in diagnos-

tic pathology, immunohistochemistry, and

molecular techniques have substantially

improved our understanding of these le-

sions; however, significant diagnostic and

prognostic challenges remain. Over the past

decades, numerous aspects of papillary tu-

mor classification, biological behavior, and

clinical management have been extensively

investigated and, in some cases, remain con-

troversial, with each new contribution offer-

ing incremental clarification 4,13.

More recently, molecular approaches

have enabled genomic and transcriptomic

characterization of papillary breast tu-

mors, providing additional insights into

their pathogenesis and potential clinical

Fig. 2. Histopathological and immunohistochemical features of a case of encapsulated papillary carcinoma. A:

Hematoxylin and eosin–stained section of a case in which encapsulated papillary carcinoma was initially

suspected on Tru-Cut biopsy and subsequently confirmed on excisional material (×40); B: Immunohis-

tochemical staining with p63 demonstrating absence of the myoepithelial layer (×40); C: Immunohis-

tochemical staining for estrogen receptor (ER) showing diffuse, strong nuclear positivity (100%) (×40);

D: Immunohistochemical staining for Ki-67 demonstrating a proliferative index of 30% (×40).

296 Devrim et al.

Investigación Clínica 67(2): 2026

behavior1,3,13,14. Despite these advances, the

biological significance and optimal man-

agement of certain papillary lesions—par-

ticularly those diagnosed from limited CNB

material—remain incompletely understood,

underscoring the ongoing need for compre-

hensive histopathological evaluation and

clinicopathological correlation.

Numerous studies have examined the

diagnostic performance and clinical man-

agement of papillary neoplasms identified

on CNB; however, reported rates of underdi-

agnosis and diagnostic upgrade on excision

vary widely across the literature. Epithelial

atypia has consistently been associated with

a substantially increased risk of upgrade to

Fig. 3. Histopathological and immunohistochemical features of a case of invasive encapsulated papillary car-

cinoma. A: Hematoxylin and eosin stained Tru-Cut biopsy section (×40) from a case diagnosed with

invasive encapsulated papillary carcinoma by both Tru-Cut biopsy and subsequent excisional biopsy;

B, C: Immunohistochemical staining with p63 (B), CK5/6 (C) and SMM (D) showing absence of

myoepithelial layer (×40); E: Immunohistochemical staining for estrogen receptor (ER) showing wi-

despread strong nuclear positivity (100%) (×40); F: Immunohistochemical staining of Ki-67 showing

a proliferative index of 15% (×40).

Core needle biopsy versus excision in papillary breast lesions 297

Vol. 67(2): 289 - 299, 2026

DCIS or invasive carcinoma, supporting cur-

rent recommendations for complete surgi-

cal excision in such cases. In contrast, the

optimal management of papillary lesions

without atypia diagnosed on CNB remains

controversial, with no clear consensus on

routine surgical excision versus imaging-

based surveillance 2.

Consistent with the findings of Puccini

et al. 2, our study showed that when diagnos-

tic upgrades were limited to DCIS or invasive

carcinoma, abnormal physical examination

findings were significant predictors of ma-

lignancy. This observation underscores the

limitations of CNB in fully characterizing

papillary lesions and reinforces the concept

that even papillary lesions without atypia di-

agnosed on CNB may carry a clinically mean-

ingful risk of upgrade at excision.

Consistent with previous reports by

Tian et al. 9, CNB in our cohort showed

high concordance in distinguishing benign

from malignant breast lesions, with only a

small number of discordant cases. Notably,

misclassification predominantly involved le-

sions with atypical ductal hyperplasia (ADH)

or ADH combined with an intraductal papil-

loma. These lesions frequently lacked overtly

suspicious sonographic features, and their

maximum tumor diameter was generally less

than 3 cm, factors that may partially explain

the diagnostic challenges encountered.

Accurate discrimination between in

situ and invasive carcinoma remains critical,

as substantial differences exist in the thera-

peutic strategies applied to these entities 15.

Pathological grading plays a central role in

guiding clinical management, influencing

decisions about surgical extent, axillary eval-

uation, and the need for adjuvant therapy.

Consequently, precise histopathological as-

sessment is essential to optimizing patient

outcomes.

Intralesional heterogeneity is a defining

biological feature of papillary breast lesions

and has important diagnostic implications16.

Atypical papillary lesions, in particular, of-

ten show focal architectural atypia and lo-

calized disruptions of the myoepithelial cell

layer. Immunohistochemical analysis may

therefore reveal focal loss of CK5/6 expres-

sion confined to atypical regions. Similarly,

proliferation indices show marked regional

variability across benign, atypical, and ma-

lignant papillary lesions, with differences

between low- and high-proliferative areas re-

ported to reach up to 44%.

Collectively, these observations indi-

cate that asymmetric growth and intral-

esional heterogeneity are intrinsic features

of many papillary lesions. This heterogeneity

highlights the inherent limitations of CNB,

as limited sampling may miss the most di-

agnostically significant areas, potentially

leading to underdiagnosis. These findings

support continued recommendations for

surgical excision when atypia is identified or

when lesion heterogeneity raises concerns

about sampling adequacy 17.

Managing patients diagnosed with be-

nign intraductal papilloma on CNB remains

particularly challenging. Although most of

these lesions are truly benign, reported rates

of upgrade to atypia or malignancy on exci-

sion are high enough to warrant concern. As

a result, many clinicians favor routine surgi-

cal excision to establish a definitive diagno-

sis. However, this approach inevitably leads

to overtreatment, given that the incremen-

tal breast cancer risk associated with a soli-

tary benign papilloma is comparable to that

of usual ductal hyperplasia. These consider-

ations underscore the need for improved risk

stratification strategies to more accurately

identify patients who would benefit from sur-

gical intervention 17.

Finally, the relatively low underestima-

tion rates for DCIS and ADH reported with

CNB have important implications for surgi-

cal planning. When subsequent excision is

performed, surgeons may reasonably assume

a low likelihood of occult invasive carcino-

ma, supporting breast-conserving surgical

approaches. In such cases, axillary lymph

node sampling may be safely omitted, given

the low probability of invasive disease 18.

298 Devrim et al.

Investigación Clínica 67(2): 2026

This review has several limitations. In

several of the included studies, incomplete

or inconsistent reporting limited a rigor-

ous assessment of methodological quality

and hindered accurate evaluation of the

potential impact of bias on study findings.

Furthermore, substantial heterogeneity in

study designs, diagnostic thresholds, and

histopathological criteria limited mean-

ingful cross-study comparisons and likely

contributed to variability in reported out-

comes.

To strengthen the evidence base, future

high-quality prospective diagnostic accuracy

studies using standardized reporting frame-

works are needed. Such studies would en-

able more robust validation of current find-

ings and help mitigate the impact of residual

methodological limitations.

In conclusion, given the well-document-

ed potential for underestimation—not only

of carcinoma but also of atypical prolifera-

tive lesions—surgical excision remains a jus-

tified and prudent management strategy for

papillary breast lesions identified on CNB.

When a papillary lesion is detected on CNB,

surgical excision carries a substantial likeli-

hood of revealing atypia or an associated ma-

lignancy, either within the index lesion or in

adjacent breast tissue.

Funding

The authors declared that this study re-

ceived no financial support.

ORCID ID of the authors

•Tuba Devrim (TD):

0000-0002-5321-2002

•Gamze Erkılınç (GE):

0000-0003-4704-7415

•Saniye Sevim Tuncer (SST):

0000-0003-0872-7493

•Şaziye Ceren Pehlivan (SCP):

0009-0002-1514-3648

•Fazilet Uğur Duman (FUD):

0000-0002-5721-9746

•Eyup Kebapci (EK):

0000-0001-8900-2325

Author's contributions

TD drafted the manuscript and con-

ducted the statistical analyses. GE, SST,

SCP, FUD, and EK contributed to the study’s

conception and design. All authors critically

reviewed and approved the final manuscript.

Part of this study was given as an oral

presentation at the 34th National Pathology

Congress, held in November 12-16, 2025 in

İzmir/Turkey.

Conflict of interest

All authors participating in the study

declare that there is no conflict of interest.

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