Microcalcification Is an Important Factor in the Management of Breast Intraductal Papillomas Diagnosed on Core Biopsy

Abstract

The follow-up excision (FUE) results were analyzed from 370 cases diagnosed as intraductal papilloma on breast core needle biopsy (CNB) with no history of malignancy or other risk factors. Of these cases, 98.6% were rendered a Breast Imaging Reporting and Data System score of 4 on mammography before the CNB. Fifty-one cases (13.8%) were found to have microcalcifications on microscopic examination of CNB. A total of 7 (1.9%) of 370 cases were upgraded to invasive carcinoma, ductal carcinoma in situ, or pleomorphic lobular carcinoma in situ on FUE. Six of 51 (11.8%) cases with microcalcifications found on imaging and CNB were upgraded to ductal carcinoma in situ or invasive carcinoma, whereas only 1 (0.3%) of 319 cases without microcalcifications was upgraded to pleomorphic lobular carcinoma in situ (P = .003). Results of a multivariate analysis adjusted for age confirmed that microcalcifications was a risk factor for upgrading to cancer, independent of age. Our results indicate that surgical excision is required for intraductal papilloma diagnosed on CNB if microcalcifications are present. However, excision may not be required for those who have no microcalcifications on CNB and no other known risk factors.

Breast intraductal papillomas without atypia in radiologic‐pathologic concordant core‐needle biopsies: Rate of upgrade to carcinoma at excision

“…Li et al 13 studied a population of similar ethnic composition (77% Caucasian, and 19.5% African American), and reported a 1.9% upgrade rate, similar to our study. In contrast, 70% of patients in the study of Rizzo et al were African American, and the upgrade rate was higher 6 .…”

“…Glenn et al 21 , however, described an upgrade rate of 4.7% in IDPs measuring <15 mm, but did not report radiologic-pathologic concordance. Other authors have shown that size by imaging is not predictive of upgrade 13,21 . In our study, the mean imaging size of lesions with and without upgrade was comparable (9.8±2.3 mm vs 9±0.5 mm, respectively).…”

“…The integrated evaluation of imaging and CNB histological findings directs the management of patients with breast lesions, and radiologic-pathologic discordant findings always mandate EXC 11 . A few more recent series have reported low upgrade rates at EXC of lesions yielding IDP at CNB 12,13 , concluding that EXC is not required, and imaging surveillance is sufficient. A number of radiologic and histologic features predictive of the upgrade of IDP have been suggested, including size ≥1.5 mm on imaging 14 , presence of microcalcifications 13 , and older patient age 15 .…”

Intraductal Papilloma Without Atypia on Image- Guided Breast Biopsy: Upgrade Rates to Carcinoma at Surgical Excision

“…Previous studies investigated which clinical and imaging features are predictive for an upgrade to carcinoma and suggested characteristics such as larger lesion size [7], presence of microcalcifications [14], older patient age [5], and palpable mass lesions [11]. However, to our knowledge, almost all of these previous studies focused on only a single imaging modality, and there is still no consensus as to which imaging features warrant surgical excision.…”

Papillomas of the Breast 15 mm or Smaller: 4-Year Experience in a Community-Based Dedicated Breast Imaging Clinic

“…[3][4][5][6][7][8][9][10][11] Others favor imaging follow-up in some or all biopsy-proven benign papillomas. [12][13][14][15] As a result, the management of suspected intraductal papillomas has become challenging.…”