Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: Scoring system for predicting malignancy

Ahn, Seung-Ho; Han, Wonshik; Moon, Hyeong‐Gon; Kim, Min Kyoon; Noh, Dong‐Young; Jung, Bong Wha; Kim, Sung Won; Ko, Eunyoung

doi:10.1016/j.ejso.2017.10.214

Cited by 38 publications

(38 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While many clinicians would agree not to treat asymptomatic IDP with surgical excision, the treatment decision still varies. Clinical observational studies showed that IDP may progress to IDC of no special type or cribriform subtypes 4 or co-exist with DCIS/IDC [14][15][16][17] of various morphologies and grades 14,18 . Here we find that the absence of CN events, regardless of histopathological subtype, symptoms or age of the patient, is strongly associated with lack of progression potential, raising the possibility that IDP showing no CN events could be spared from routine surgical excision.…”

Section: Discussionmentioning

confidence: 99%

“…Although a diagnosis of IDP carries an increased risk of developing breast cancer, it has long been suggested that IDP could only directly progress to PC. However, it is still inexplicable why IDP has been observed to co-exist with the more common non-papillary forms of ductal carcinoma in situ (DCIS)/ invasive ductal carcinoma (IDC) [14][15][16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The genetic architecture of breast papillary lesions as a predictor of progression to carcinoma

et al. 2020

View full text Add to dashboard Cite

Intraductal papillomas (IDP) are challenging breast findings because of their variable risk of progression to malignancy. The molecular events driving IDP development and genomic features of malignant progression are poorly understood. In this study, genome-wide CNA and/or targeted mutation analysis was performed on 44 cases of IDP, of which 20 cases had coexisting ductal carcinoma in situ (DCIS), papillary DCIS or invasive ductal carcinoma (IDC). CNA were rare in pure IDP, but 69% carried an activating PIK3CA mutation. Among the synchronous IDP cases, 55% (11/20) were clonally related to the synchronous DCIS and/or IDC, only one of which had papillary histology. In contrast to pure IDP, PIK3CA mutations were absent from clonal cases. CNAs in any of chromosomes 1, 16 or 11 were significantly enriched in clonal IDP lesions compared to pure and non-clonal IDP. The observation that 55% of IDP are clonal to DCIS/IDC indicates that IDP can be a direct precursor for breast carcinoma, not limited to the papillary type. The absence of PIK3CA mutations and presence of CNAs in IDP could be used clinically to identify patients at high risk of progression to carcinoma.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The genetic architecture of breast papillary lesions as a predictor of progression to carcinoma

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In our study, we focused on ablation treatment of central IDP without atypia. For IDP with atypia diagnosed with a core needle biopsy, excision is generally recommended to rule out a potential concurrent malignant neoplasm; IDP with atypia has a confirmed upgrade rate as high as 40.8% [16,19]. However, for IDPs without atypia, the recommendations for excision versus observation vary.…”

Section: Discussionmentioning

confidence: 99%

“…All lesions should be pathologically diagnosed using core needle biopsy. In addition, we used a scoring system developed by Ahn et al, with good sensitivity and negative predictive value associated with a score 4 for a likely benign diagnosis, to assist clinicians in decision-making [16]. 2Careful US scanning and US combined with MRI scans are necessary to identify the size, border, and location of the IDP before ablation.…”

Section: Discussionmentioning

confidence: 99%

“…All IDPs were <5 mm from the nipple. Ahn et al developed a scoring system to predict malignancy in IDP based on clinical, radiological, and pathological factors including bloody nipple discharge (scoring 3.4), size on imaging !15 mm (scoring 1.9), BI-RADS !4 b (scoring 1.6), peripheral location (scoring 2.7), and palpable lesion (scoring 1.8) as independent predictors of malignancy in benign papilloma without atypia [16]. We used a total score 4 for five factors as the recommended cutoff value, as an auxiliary method to determine the probability of a benign lesion.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Ultrasound-guided percutaneous microwave ablation of central intraductal papilloma: a prospective pilot study

Meng

et al. 2019

International Journal of Hyperthermia

View full text Add to dashboard Cite

Background: Central intraductal papilloma (IDP) has a low risk of cancer evolution; therefore, surgical treatment of IDP is controversial. We sought to validate ultrasound (US)-guided percutaneous microwave ablation (MWA) for minimally invasive treatment of IDP. Methods: Thirteen women with central IDP, including six with nipple discharge, underwent US-guided core needle biopsy and MWA from December 2016 to November 2017. Lesions histologically diagnosed as benign IDP were included. The hydro-dissection technique was used to protect the nipple during the entire ablation procedure. We evaluated and recorded data of complete ablation, volume reduction, and complications. Results: MWA was successfully performed in all patients, with 100% complete ablation, assessed by magnetic resonance imaging or contrast-enhanced US. Mean tumor size was 13.5 ± 4.1 (7.0-20.0) mm; the mean ablation time was 1.4 (0.7-10.3) min. At the median 13.7-month follow-up, mean lesion sizes at 3, 6, and 12 months after MWA were all significantly smaller than that at baseline. Total volume reduction rates were 52.3 ± 18.2% (range, 24.2-81.8%), 72.6 ± 23.1% (range, 39.4-95.9%), and 92.9 ± 7.5% (range, 75.0-100%) at 3-, 6-, and 12-month follow-up, respectively, with significant differences (p < .01). Three lesions with diameters 7 mm, 9 mm, and 12 mm disappeared completely at 3, 6, and 6 months after MWA, respectively, on US imaging. Nipple discharge disappeared immediately after MWA. Cosmetic effects were reported as excellent by all patients and no complications were observed. Conclusion: US-guided MWA of central IDP proved feasible and effective, with considerable volume reduction and satisfactory cosmetic outcomes.

show abstract

Malignant upgrade rate and associated clinicopathologic predictors for concordant intraductal papilloma without atypia: A systematic review and meta‐analysis

Keating,

Cevik,

Hopkins

et al. 2024

Journal of Surgical Oncology

View full text Add to dashboard Cite

Previously reported upgrade rates for benign breast intraductal papilloma (IDP) are widely variable. However, many previous studies have failed to consider radiologic‐pathologic discordance of lesions. This review aims to synthesize malignant upgrade data for benign, concordant IDP at surgical excision. Thirteen studies were included in our meta‐analysis. The pooled estimate for percentage underestimation of carcinoma was 1.4% (95% CI: 0.8%−2.0%). We conclude that these lesions can be safely managed by active surveillance.

show abstract

Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: Scoring system for predicting malignancy

Cited by 38 publications

References 28 publications

The genetic architecture of breast papillary lesions as a predictor of progression to carcinoma

The genetic architecture of breast papillary lesions as a predictor of progression to carcinoma

Ultrasound-guided percutaneous microwave ablation of central intraductal papilloma: a prospective pilot study

Malignant upgrade rate and associated clinicopathologic predictors for concordant intraductal papilloma without atypia: A systematic review and meta‐analysis

Contact Info

Product

Resources

About