Papillary lesions of the breast are fairly common on imaging-guided breast biopsy, and the management remains controversial. Due to the heterogeneity of histological findings, papilloma can be a challenge to the pathologist when interpreting core biopsy specimens, so some may desire the entire lesion to be removed to be confident of the diagnosis of a benign papilloma. In appropriate cases, an attempt at removal with vacuum-assisted biopsy appears a reasonable approach with the hopes of establishing a diagnosis, relieving symptoms of nipple discharge, and avoiding the cost and morbidity of surgical intervention. The management of lesions with atypia on mammotome excision will remain controversial and the prudent approach is to recommend complete surgical excision.
