Papillary breast lesions are a heterogeneous group of neoplasms of diverse imagenological, clinical and morphological presentation that display different behaviour, prognosis and, therefore, controversial diagnosis and management. The aim of this study is to propose an algorithm for the management of mammary lesions.

Materials and methods: We show a retrospective review of breast imaging reporting, percutaneous needle biopsy information, histological-pathological reports and subsequent management.

Results: A total of 7,920 biopsies were reviewed. Only 136 biopsies from 130 patients with papillary lesions met the inclusion criteria. There was a correlation between the pathologic findings from percutaneous biopsy and the final surgical histologic result in patients with surgery recommendation in all but 2 (2.12%) cases in which the surgery results were upgraded to a malignant disease.

Conclusions: The algorithm proposed in this paper for the management of mammary lesions significantly reduces the possibilities of upgrading and favours decision making between follow-ups or surgery in patients with papillary lesions of the breast.