Breast Cancer Risk Associated With Benign Intraductal Papillomas Initially Diagnosed on Core Needle Biopsy

Nasehi, Leyla; Sturgis, Charles D.; Sharma, Nidhi; Turk, Paulette; Calhoun, Benjamin C.

doi:10.1016/j.clbc.2018.06.011

Cited by 9 publications

(9 citation statements)

References 42 publications

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“…Khan the cumulative breast cancer incidence was 14% at a median of 9 years. 18 Moynihan et al reported that out of a total 15 patients who were upgraded to the high-risk papillary breast lesions, one patient had developed DCIS on the contralateral breast several years after excision of breast papilloma, but there was no development of DCIS or invasive carcinoma on the ipsilateral breast after a mean follow-up of 2.9 years. 19 These studies reported various cumulative breast cancer incidence rates but did not describe the risk factors associated with subsequent development of breast cancer other than atypia.…”

Section: Discussionmentioning

confidence: 99%

“…Most papillary breast lesions are considered as benign lesions; however, previous findings in the literature have shown an increased risk of malignancy in papillary breast lesions 4,8,11–16 . In addition, recent studies reported diverse upgrade rates of papillary breast lesions after surgical excision, ranging .8%–39% 7,8,16–18 . A meta‐analysis by Wen et al 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Nasehi et al. followed 55 patients who had benign IDPs on CNB and were not upgraded on excision and reported the cumulative breast cancer incidence was 14% at a median of 9 years 18 . Moynihan et al.…”

Section: Discussionmentioning

confidence: 99%

“…7,8,[16][17][18] A meta-analysis by Wen et al9 analyzed a total of 34 studies including 2236 nonmalignant papillary breast lesions diagnosed on CNB and reported the upgrade rate of 15.7% (95% CI 12.8%-18.5%). In this study, we also investigated the upgrade rate of papillary breast lesionsTA B L E 2Abbreviations: BIRADS, breast imaging reporting and data system; CNB, core needle biopsy; SD, standard deviation; US, ultrasound.…”

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confidence: 99%

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Factors associated with upgrade, malignant upgrade, and subsequent breast cancer occurrence of papillary breast lesions diagnosed on core needle biopsy

Park

Lee

et al. 2022

Asia-Pac J Clncl Oncology

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Aim: In this study, we analyzed the upgrade rate and associated factors for upgrade, malignant upgrade, and subsequent breast cancer occurrence of papillary breast lesions diagnosed on core needle biopsy (CNB).Methods: One hundred sixty-nine patients who underwent surgery for the treatment of papillary breast lesions diagnosed on CNB were included in this study. Medical records including radiological and pathological reports were retrospectively reviewed. Results:The overall upgrade rate was 29.6%, and upgrade rate to malignancy was 16.6%. Age over 45 years, preoperative tumor size ≥0.7 cm on breast ultrasound, pathologic tumor size ≥0.4 cm, breast imaging reporting and data system (BIRADS) category 4b or 4c, and personal history of breast cancer were associated with upgrade.In addition, age over 45 years, preoperative tumor size ≥0.9 cm, pathologic tumor size ≥0.6 cm, atypia in CNB, and BIRADS category 4b or 4c were associated with malignancy. The risk of subsequent breast cancer occurrence was increased in preoperative tumor size ≥0.8 cm, pathologic tumor size ≥0.5 cm, multiple and recurrent lesions. Conclusion:Our study showed high upgrade rate of papillary breast lesions diagnosed on CNB. Our findings suggest that surgical excision is recommended for papillary breast lesions diagnosed on CNB in selected patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Factors associated with upgrade, malignant upgrade, and subsequent breast cancer occurrence of papillary breast lesions diagnosed on core needle biopsy

Park

Lee

et al. 2022

Asia-Pac J Clncl Oncology

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“…Historically, higher upgrade rates reported in earlier studies (as high as >30%) led some authors to suggest the excision of all papillomas. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] However, many of these studies are limited by small sample sizes and potential confounding factors. 18 More recently, a review of the literature 1 determined the upgrade rate from papilloma to DCIS or invasive carcinoma when accounting for confounding factors was most often <5%, [5][6][7][8][9][10][11][14][15][16][17] with some groups demonstrating a rate of 5% to 10%.…”

Section: Introductionmentioning

confidence: 99%

Upgrade Rate and Predictive Factors Associated With Breast Papillary Lesions on Core Biopsy: A Canadian Experience

et al. 2022

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Background: Papillary lesions of the breast are a heterogeneous group, encompassing a wide range of lesions. The histologic distinction between papillary breast lesions remains challenging, especially on core biopsy specimens. Aim: This study aimed to determine the rate of upgrade to atypia or malignancy of biopsy-proven papillary lesions on surgical follow-up and to assess for factors associated with an upgrade in Greater Vancouver, BC, Canada. Materials and Methods: This is a retrospective population-based study of all breast papillary lesions diagnosed on core biopsy between 2017 and 2019 in the Fraser Health Authority in Greater Vancouver, Canada. Patients were retrieved from the laboratory information system. Patient demographics, histopathologic, and radiologic findings were analyzed. Results: A total of 269 specimens from 269 patients (mean 61.1 years), including 265 female and 4 male patients, were included in the study. Of the 269 specimens, 129 (48%) were intraductal papillomas and 140 (52%) were atypical papillary lesions. The overall upgrade rate among papillomas was 11.6% (15 of 129) on final excision. The mean age of patients diagnosed with papilloma on core biopsy was significantly younger than those with atypical papillary lesions (55.6 vs 66.1 years, P < .0001). Lesion size in patients with papillomas on core biopsy was significantly smaller than those with atypical papillary lesions (11.1 vs 15.1 mm, P = .001). The upgrade rates in patients <55 and ≥55 years were 4.9% and 13.2%. Size ( P = .004) and atypia on core biopsy ( P = .009) were significantly associated with upgrade. Older age (>55 years) (OR = 5.3, 95% CI: 1.04-27.08) was an independent predictor of upgrade among papillomas. Size, location, and Breast Imaging-Reporting and Data System (BI-RADS) radiologic categories in our study were not associated with predicting the upgrade of papillomas. Conclusion: Our data suggest that the risk of upgrade to atypia or malignancy is sufficient to warrant the excision of benign papillomas of any size in patients aged ≥55 years. In patients younger than 55 years, observation with close clinical and radiological follow-up without surgery may be sufficient. Our findings also support surgical excision of papillomas diagnosed on core biopsy when associated with atypia.

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Imaging of the Symptomatic Breast

Shetty

2021

Breast &Amp; Gynecological Diseases

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Breast Cancer Risk Associated With Benign Intraductal Papillomas Initially Diagnosed on Core Needle Biopsy

Cited by 9 publications

References 42 publications

Factors associated with upgrade, malignant upgrade, and subsequent breast cancer occurrence of papillary breast lesions diagnosed on core needle biopsy

Factors associated with upgrade, malignant upgrade, and subsequent breast cancer occurrence of papillary breast lesions diagnosed on core needle biopsy

Upgrade Rate and Predictive Factors Associated With Breast Papillary Lesions on Core Biopsy: A Canadian Experience

Imaging of the Symptomatic Breast

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