Objective: Papillary lesions of the breast (PLB) comprehend a spectrum of entities with different morphologies and malignancy risk, which present a diagnosis challenge on core biopsy (CB). Although diagnostic accuracy has improved with immunohistochemistry, the need to excise benign PLB remains controversial. The aim of our study is to determine CB diagnosis accuracy in PLB, and subsequent need to excise all lesions. Method: A retrospective study of PLB diagnosed by CB in our department between 01/01/2000 and 31/12/2011 was performed. Results: 96 cases were identified, with a median age of 59 years. CB diagnosis was benign in 66 cases, some kind of atypia found in 10, and malignant lesions ('in situ' and encysted/invasive types of carcinoma) in 20. Surgical excision was performed on 70 cases, including all cases with carcinoma. Following excision, 6/42 and 4/42 benign CB results were respectively upgraded to atypical and malignant; 3/8 with atypia were upgraded to malignant. Overall, 14 % (7/50) of benign and atypical PLB CB diagnosis therefore missed malignancy. Conclusion: Our results show that, despite good correlation between CB and excision diagnosis, some cases of carcinoma are missed on CB, so the excision of all PLB remains advisable. *FM and MC are joint first authors.