Benign breast papillomas diagnosed by CNB have a low risk of malignancy and do not need excision. However, they should be considered high risk lesions which require serial radiographic monitoring. Papillomas associated with atypia or malignancy should continue to be excised.

Lupus Mastitis (LM) is a rare presentation of lupus panniculitis involving the breast. Because it often presents as a tender palpable mass, a workup for malignancy usually ensues. It is well documented that surgery may worsen the condition; therefore, it is important to consider LM in the differential of a palpable breast mass in patients with systemic lupus erythematosus (SLE). Currently, management of LM remains primarily medical. We discuss the multi-disciplinary work-up of LM, and further describe its appearance on serial Magnetic Resonance (MR) exams.

The objective of our study is to determine if a carefully selected subset of benign breast papillomas (size ≤1.5 cm) can be safely followed by imaging surveillance instead of immediate surgical excision. Over a 6½-year period, 86 breast lesions were diagnosed as a benign papilloma (BP) utilizing an 11- or 8-gauge vacuum-assisted core needle biopsy (VACNB) device. In general, it was our intent to remove as much of the radiologically evident lesion as possible. These 86 lesions underwent ≥2 years of imaging surveillance, without surgical excision following initial detection. With ≥2 years of radiologic follow-up, none of the 86 BPs demonstrated imaging findings that necessitated repeat biopsy or surgical excision. Benign breast papillomas ≤1.5 cm that are biopsied using an 11- or 8-gauge VACNB device with intent to remove as much of the radiologically evident lesion as possible are safe to undergo serial imaging surveillance rather than immediate surgical excision.

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