Is Surgical Excision Necessary in Breast Papillomas 10 mm or Smaller at Core Biopsy

Yang, Yang; Fan, Zhaoqing; Liu, Yiqiang; He, Yingjian; Ouyang, Tao

doi:10.1159/000481097

Cited by 12 publications

(13 citation statements)

References 13 publications

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“…In our cohort, papillary lesions without atypia had an overall upgrade rate of 4.72%, which is consistent with recent international series which report overall upgrade rates of 2.3–7% 8–10 . Of these lesions, those larger than 8 mm demonstrated a higher upgrade rate (13.63%) than those smaller than 8 mm (0%).…”

Section: Discussionsupporting

confidence: 91%

“…[5][6][7] In our cohort, papillary lesions without atypia had an overall upgrade rate of 4.72%, which is consistent with recent international series which report overall upgrade rates of 2.3-7%. [8][9][10] Of these lesions, those larger than 8 mm demonstrated a higher upgrade rate (13.63%) than those smaller than 8 mm (0%). A similar finding was reported by Yu et al, who found that papillary lesions larger than 15 mm, regardless of whether atypia was present, have a statistically significant increased risk of malignancy on excision.…”

Section: Discussionmentioning

confidence: 99%

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B3 lesion upgrade rates in a tertiary Australian breast centre: a 8‐year experience (2012–2019)

Huang

Park

McLaren

et al. 2020

ANZ Journal of Surgery

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Background: B3 breast lesions identified on core needle biopsy have uncertain malignant potential. Traditional management of these lesions has been surgical excision, but there is growing interest in less invasive and more cost-effective alternatives such as vacuumassisted excisional biopsy (VAEB). Determining the rate of malignant upgrade for B3 lesions is important as it may identify low-risk lesions where VAEB could be considered. Methods: A retrospective study was conducted of women undergoing an elective excisional biopsy for a B3 lesion identified on core needle biopsy at a tertiary Australian breast centre. The pre-operative biopsy diagnosis and subsequent excisional biopsy diagnosis were used to calculate the proportion of cases where the diagnosis was upgraded to malignancy. Results: A total of 299 eligible patients were identified. Pre-operative diagnosis of papillary lesion with atypia was associated with the highest upgrade rate (50%, n = 12). The next highest upgrade rates occurred in those with flat epithelial atypia (37.50%, n = 8); atypical ductal hyperplasia (24.71%, n = 85); lobular carcinoma in situ (LCIS)/atypical lobular hyperplasia with calcification (17.65%, n = 17); and papillary lesion without atypia (4.72%, n = 106). Patients with radial scar (n = 51), classical LCIS without calcification (n = 7) and mucocoele-like lesion (n = 8) had a 0% upgrade rate. Conclusion: VAEB may be appropriate for low malignant risk lesions such as papillary lesion without atypia, mucocoele-like lesion and radial scar lesion without atypia. Opensurgical-excisional biopsy remains appropriate for high upgrade lesions such as atypical ductal hyperplasia, papillary lesion with atypia, flat epithelial atypia and classical LCIS with calcification. Long-term prospective randomized multicentre studies and continuing multidisciplinary approach is recommended for future clinical implementation.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

B3 lesion upgrade rates in a tertiary Australian breast centre: a 8‐year experience (2012–2019)

Huang

Park

McLaren

et al. 2020

ANZ Journal of Surgery

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“…50%No association with age and size lesionKo et al 2017 [63] n = 346 PL in CNBUpgradeIn VAB ( n = 211)In OE ( n = 135)UpgradeOverall in 2.3%If size < 1cm: 0.9%Size of PL correlates with upgradeClose follow-up with ultrasound instead of excisionMoon et al 2016 [64] n = 65 PL in CNBUpgradeIn VAB ( n = 12)In OE ( n = 53)UpgradeIn OE in 9% (5/53)In VAB 8% (1/12)No recommendationNiinikoski et al 2018 [65] n = 80 PL in CNBSmall PL in selected patients-OE can be avoidedPareja et al. 2016 [66]Upgrade in OE ( n = 171) after PL Without atypiaIn CNBUpgradeIn OE 2.3% (4/171)Regardless of size, observation is appropriate at radiologic–pathologic concordant CNBSeely et al 2017 [67] n = 107 PL in OEUpgrade afterVAB ( n = 60)CNB ( n = 47)Upgrade in OEAfter VAB in 1.6% (1/60)After CNB in 8.5% (4/47)Higher upgrade in OE if PL is diagnosed on CNBTatarian et al 2016 [68] n = 16 PL in CNBUpgrade in OEUpgrade in OEIn 2/16 cases (12.5%)Surgical excision should be considered in patients with benign papillomasTran et al 2017 [69] n = 43 PL in CNBUpgrade in OEUpgrade in OEIn 1/43 cases (2%)Low-upgrade rate in OEWyss et al 2014 [70] n = 156 PL in CNBUpgradeIn VAB ( n = 135) andFollow-up ( n = 21)(Median 3.5 years)Upgrade after follow-up1.2% (2/156)VAB is recommended as the method of choice for removal of PLYamaguchi et al 2015 [71] n = 142 PLFollow-up imagingAfter VAB ( n = 125)After CNB ( n = 17)Upgrade in OE ( n = 17)4/17Discordant lesions should undergo OEYang et al 2018 [72] n = 116 PL(On CNB or VAB)10 mm or smallerOE n = 74Surveillance n = 42Overall upgrade 11% (13/116)Upgrade after VAB (0%)Upgrade after CNB (16.5%)Higher upgrade in OE-After CNB-Older age-Pl with atypia…”

Section: Resultsmentioning

confidence: 99%

Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Rageth

O’Flynn

Pinker

et al. 2018

Breast Cancer Res Treat

199

261

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Purpose The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the consensus recommendations. Methods This study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy. Results In 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN [65% in 2018 vs. 51% in 2016 ( p = 0.004)], FEA (72% in 2018 vs. 62% in 2016 ( p = 0.005)), and PL [(76% in 2018 vs. 70% in 2016 ( p = 0.04)] diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS [77% in 2018 vs. 67% in 2016 ( p = 0.07)]. Conclusions Minimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN.

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“…Surgical management of intraductal papilloma diagnosed on core biopsy is controversial. Some authors have suggested that intraductal papilloma greater than five millimetres should be excised [9]. In our study, the majority of intraductal papillomas were less than five centimetres (52.5%), and more than 90% were solitary.…”

Section: H and E Hematoxylin And Eosinsupporting

confidence: 46%

Spectrum of Papillary Breast Lesions According to World Health Organization Classification of Papillary Neoplasms of Breast

Hashmi

Faraz

Rafique

et al. 2020

Cureus

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Introduction Papillary breast lesions are segregated into benign and malignant based on the presence or absence of myoepithelial cells in the papillary cores. Papillary breast lesions are further classified into: intraductal papilloma, papilloma with atypical ductal hyperplasia (ADH)/ductal carcinoma in situ (DCIS), papillary DCIS, solid papillary carcinoma in situ, solid papillary carcinoma with invasion, invasive solid papillary carcinoma, encapsulated papillary carcinoma and encapsulated papillary carcinoma with invasion. In this study, we evaluated the spectrum of papillary breast lesions in resection specimens of the breast according to the latest World Health Organization (WHO) classification of breast tumors. Methods This was a retrospective cross-sectional study, and was conducted at Liaquat National Hospital for a period of six years, from January 2012 till December 2017. Data of patients that underwent surgeries for breast tumors were included in the study. All specimens were grossed, according to defined protocols, and representative sections were taken after inking resection margins. Hematoxylin and eosin-stained sections were examined by experienced histopathologists, and myoepithelial stains (p63 and myosin) were done in selected sections of all tumors. Histopathological classification of papillary tumors was performed according to WHO classification of breast tumors. Results The study involved 190 excision specimens of papillary breast lesions. Mean age of the patients was 45.6±17.1 years. Most of the lesions were between two and five centimetres (69.1%). For invasive carcinomas (n = 76), the most frequent grade was II (52.6%). For in situ and invasive carcinomas (n = 129), lymphovascular invasion and axillary metastasis were noted in 5.4% and 9.3% cases, respectively. Among papillary breast lesions, 36.8% were benign (intraductal papilloma, solitary or multiple) while 63.2% harbored ADH, DCIS, or invasive carcinoma. Invasive papillary carcinoma was the most frequent malignant papillary lesion (20%), followed by solid papillary carcinoma with invasion (12.6%). We found significant associations between patient's age and tumor size with histological type of papillary lesion as benign papillary lesions had smaller size and younger age compared to malignant papillary lesions. Conclusion We noted a high frequency of malignancy in papillary breast lesions. Moreover, malignant papillary lesions were significantly associated with higher age and larger tumor size.

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Is Surgical Excision Necessary in Breast Papillomas 10 mm or Smaller at Core Biopsy

Cited by 12 publications

References 13 publications

B3 lesion upgrade rates in a tertiary Australian breast centre: a 8‐year experience (2012–2019)

B3 lesion upgrade rates in a tertiary Australian breast centre: a 8‐year experience (2012–2019)

Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Spectrum of Papillary Breast Lesions According to World Health Organization Classification of Papillary Neoplasms of Breast

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