Papillary lesions of breast on core-needle biopsy: Factors associated with malignant upgrade on surgical excision

Lesion size ≥1 cm, presence of intralesional vascularity, non-circumscribed margins, and atypia on CNB specimens are significant predictors of malignant upgrade in patients with PLs on CNB. Low-risk lesions (subcentimeter circumscribed lesions without vascularity and atypia) may be managed with minimally invasive approaches (e.g., vacuum-assisted excision) given their low upgrade rate (3.4%) and high negative predictive value (96.6%), while high-risk lesions (particularly those with atypia) warrant surgical excision.