Intraductal Papilloma with Benign Pathology on Breast Core Biopsy: To Excise or Not?

Tatarian, Talar; Lazar, Melissa; Sokas, Claire; Malhotra, Sanchi; Palazzo, Juan; Hsu, Elizabeth; Tsangaris, Theodore N.; Berger, Adam C.

doi:10.1016/j.jamcollsurg.2015.07.034

Cited by 12 publications

(20 citation statements)

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“…Our findings were similar when compared with prior studies that found that physical exam findings, such as nipple discharge and palpability of the lesion had no statistically significant association with risk of upgrade …”

Section: Discussionsupporting

confidence: 88%

“…Much has been written about the imaging features related to intraductal papillomas (IDPs), proliferative lesions of the lactiferous ducts. Management of benign, concordant IDPs found on breast core needle or vacuum assisted biopsy is typically surgical excision with reported upgrade rates varying between 0% and 25% after surgical excision …”

Section: Introductionmentioning

confidence: 99%

“…In the past, the clinical‐radiological and pathological factors that have been associated with upgrade of IDPs include size, multiplicity, presence of microcalcifications, nipple discharge, peripheral rather than central location, older age, and presence of atypia . Radiological characteristics have been unable to consistently predict upgrade …”

Section: Introductionmentioning

confidence: 99%

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Excision recommended in high-risk patients: Revisiting the diagnosis of papilloma on core biopsy in the context of patient risk

et al. 2019

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We investigate the clinical history, past medical history, and risk status in women with benign intraductal papillomas(IDP). We observed an upgrade rate of 3.9% to ductal carcinoma in situ (DCIS) and upgrade rate of 10.7% to a high‐risk lesion. Prior or concurrent atypia or cancer and high‐risk status had a significant increase risk of upgrade. Surgical excision of papillomas is recommended especially in high‐risk patients and women with concurrent or history of atypia or malignancy.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Excision recommended in high-risk patients: Revisiting the diagnosis of papilloma on core biopsy in the context of patient risk

et al. 2019

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“…However, in recent years there has been a trend toward the conservative management of papillomas without atypia, given the low reported rates of upgrade to in situ or invasive cancer. Recently published studies cite rates of upgrade to malignancy ranging from 0% to 8.9% . Current standard of care in many institutions worldwide is to excise all benign papillomas of the breast detected on core biopsy.…”

Section: Introductionmentioning

confidence: 99%

“…This is largely due to concern that percutaneous biopsy may not yield a representative sample. In recent years, a number of studies have been published attempting to clarify the most appropriate treatment action for these patients, producing conflicting results and recommendations …”

Section: Introductionmentioning

confidence: 99%

Benign breast papilloma: Is surgical excision necessary?

et al. 2019

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Does previous history of cancer or atypia predict histologic upgrade for pure intraductal papillomas diagnosed via core biopsy? A study of 490 cases at a single institution

et al. 2021

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Background Management of pure intraductal papillomas (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial given highly variable rates of upgrade in the literature. Aim We sought to identify clinical and histologic factors that predict upgrade to atypia or malignancy in a large population. Methods and results A retrospective review was performed of all cases of pure IDP diagnosed on CNB and then surgically excised at a single institution from 2008 to 2018. Clinical, radiologic, and pathologic factors were compared in the no upgrade, upgrade to atypia, or upgrade to cancer groups. Univariate analysis was performed comparing no upgrade and upgrade to cancer or atypia. Four hundred and thirty nine patients were identified with a total of 490 IDP and a median age of 50 years (range 16–85). Of these patients, 54 (12.3%) were upgraded to atypia after surgical excision and five (1.1%) were upgraded to cancer. The presence of multiple papillomas in a single patient was a significant predictor of upgrade to cancer or atypia ( p < .01), as well as age over ≥55 years ( p < .01) and a prior history of cancer ( p < .01). No other clinical, radiologic and histologic factors were found to be significant predictors of upgrade. 40/439 (9.1%) patients in the total cohort had prior history of cancer, and of these, 2/40 (5%) were found to have a new cancer after excision. Conclusions In patients with pure IDP on CNB, the upgrade rate to malignancy was 1.1%, while 12.3% were upgraded to atypia. The clinical significance of identifying atypia in a papilloma is unknown, especially in a patient with a prior history of atypia or cancer. However, the majority of patients who were upgraded to either atypia or cancer had no prior history of high‐risk or malignant breast disease and are therefore considered true clinical upgrades. As such excision for IDP should be considered.

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Intraductal Papilloma with Benign Pathology on Breast Core Biopsy: To Excise or Not?

Cited by 12 publications

References 0 publications

Excision recommended in high-risk patients: Revisiting the diagnosis of papilloma on core biopsy in the context of patient risk

Excision recommended in high-risk patients: Revisiting the diagnosis of papilloma on core biopsy in the context of patient risk

Benign breast papilloma: Is surgical excision necessary?

Does previous history of cancer or atypia predict histologic upgrade for pure intraductal papillomas diagnosed via core biopsy? A study of 490 cases at a single institution

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