Papillary Lesions of the Breast: A Review

Abstract

Papillary breast lesions are rare breast tumors that comprise a broad spectrum of diseases. Pathologically they present as mass-like projections attached to the wall of the ducts, supported by fibrovascular stalks lined by epithelial cells. On mammogram they appear as masses that can be associated with microcalcifications. Ultrasound is the most used imaging modality. On ultrasound papillary lesions appear as homogeneous solid lesions or complex intracystic lesions. A nonparallel orientation, an echogenic halo or posterior acoustic enhancement associated with microcalcifications are highly suggestive of malignancy. MRI has proven to be useful to establish the extent of the lesion. Core needle biopsy is the gold standard for diagnosis. Surgical excision is usually recommended, although treatment for papillomas without atypia is still controversial.

Accuracy and Upgrading of CNB and BI-RADS Diagnoses Compared to Excision: A Clinicopathological-Radiological Correlation of Papillary Breast Lesions and Neoplasms

“…Previous studies have demonstrated that CNB have a very high diagnostic accuracy, with a sensitivity, specificity, positive predictive value and negative predictive value of 90% or higher (Nunez et al, 2020). In the present study, the accuracy, sensitivity and specificity of CNB in the diagnosis of PBLs/Ns were about 90% with a PPV of 98.5%.…”

“…Papillary breast neoplasms (PBNs) are a heterogeneous group of epithelial tumors composed mostly of papillae. These lesions account for less than 3% of breast tumors and their classification rests on the characteristics of the epithelium and the presence and distribution of the myoepithelial cells along the papillae and around the tumor (Nunez et al, 2020;Brogi and Krystel-Whittemore, 2021). Based on the most updated World Health Organization (WHO) classification of breast neoplasms, PBNs include: intraductal papilloma (IDP) with or without atypia, papillary ductal carcinoma in situ (papillary DCIS), encapsulated papillary carcinoma (EPC), solid-papillary carcinoma (SPC; in situ and invasive), and invasive 2019; Brogi and Krystel-Whittemore, 2021).…”

“…Additionally, PBL/Ns not only constitute a pathologically heterogeneous group, but also exhibit diverse clinical and imaging criteria (Chen et al, 2019;Nunez et al, 2020). Recently, the American College of Radiology has proposed the Breast Imaging-Reporting and Data System (BI-RADS) to standardize reporting of breast imaging results and to define clear guidelines for further management.…”

Invasive papillary carcinoma of the breast: a rare case report

“…Malignant papillary neoplasm of the breast includes several microscopically distinct lesions such as DCIS (Ductal Carcinoma in Situ) arising in intra ductal papilloma, papillary DCIS, encapsulated papillary carcinoma, solid papillary carcinoma, and invasive papillary carcinoma. All malignant papillary lesions of the breast lack an intact myoepithelial cell layer (MCL) within the papillae or at the periphery of the tumor [6].…”

Treating papillary tumors of the breast—role of adjuvant treatment—a narrative review

“…Papillary tumours of the breast are rare and heterogenous lesions of the breast accounts for less than 3% of all breast tumours (1). The 5th edition of World Health Organization (WHO) Classification of Breast Tumors (2), describes these tumours in detail ranging from benign intraductal papilloma to invasive papillary carcinoma (IPC).…”