Papillary Lesions of the Breast: MRI, Ultrasound, and Mammographic Appearances

Eiada, Riham; Chong, Jennifer; Kulkarni, Supriya; Goldberg, Frank; Muradali, Derek

doi:10.2214/ajr.11.7922

Cited by 126 publications

(103 citation statements)

References 14 publications

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“…Occasionally, a benign papilloma can have spiculated margins on mammography, US, and MRI and can thus mimic malignant disease. Variable enhancement patterns have been described, making differentiation from malignancies difficult (7,8). In atypical papillomas with DCIS, MRI may play a role in evaluating the extent of DCIS.…”

Section: ) (5)mentioning

confidence: 99%

Papillary lesions of the breast: imaging findings and diagnostic challenges

Jagmohan

Pool²,

Putti³

et al. 2013

Diagn Interv Radiol

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Papillary breast lesions encompass a wide spectrum of pathologies ranging from benign lesions, such as solitary intraductal papilloma, to the uncommon papillary carcinoma. These lesions have various clinical presentations and diverse radiological features. Differentiating benign and malignant papillary lesions based on imaging features may often be difficult. Other benign and malignant pathologies can also mimic papillary lesions on imaging, and tissue diagnosis is essential. Imaging plays an important role in lesion identification, assessment of extent, tissue sampling, and follow-up. Surgical excision has been recommended for all papillary lesions due to an increased incidence of high-risk lesions and neoplasia even with percutaneous, biopsy-proven benign papillomas. This review looks at papillary breast lesions from the radiologists' standpoint and discusses the clinical, imaging, and pathological features of these lesions, as well as the role of imaging in their evaluation. P apillary lesions in the breast are uncommon but arise from a wide range of pathologies and have diverse clinical and imaging features. A papillary lesion is characterized by an arborescent structure composed of fibrovascular stalks covered by a layer of epithelial cells with or without an intervening myoepithelial cell layer (1). Overlapping features make differentiation of benign and malignant papillary lesions difficult on imaging, and a tissue diagnosis is essential. Definitive histopathologic diagnosis on core biopsy can occasionally be difficult. Additionally, even those lesions shown by percutaneous biopsy to be benign papillomas are associated with an increased likelihood of high-risk lesions and neoplasia. Due to nonspecific findings on imaging and histopathology, as well as varying malignant potential, papillary lesions present significant diagnostic and management challenges for the radiologists, pathologists, and surgeons. We briefly review the types of papillary lesions, multimodality imaging findings, and the radiologist's role in their evaluation. The types and clinical features of papillary lesionsPapillary lesions can be broadly categorized as benign or malignant. Benign papillary lesions include a solitary intraductal papilloma, multiple intraductal papillomas, and atypical ductal hyperplasia (ADH) within a papilloma. Malignant papillary lesions include ductal carcinoma in situ (DCIS) arising in a papilloma, papillary DCIS, intracystic or encapsulated papillary carcinoma, solid papillary carcinoma, invasive papillary carcinoma arising in an intracystic papillary carcinoma, and invasive papillary carcinoma (1). Intraductal papillomaSolitary papillomas arise from a large central duct, are more common in perimenopausal women, and present with nipple discharge. Multiple papillomas are peripheral lesions arising from the terminal duct lobular unit. These are less common, usually affect a younger age group, and present as a palpable mass. Both can be associated with proliferative and high-risk lesions, such as radial ...

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Section: ) (5)mentioning

confidence: 99%

Papillary lesions of the breast: imaging findings and diagnostic challenges

Jagmohan

Pool²,

Putti³

et al. 2013

Diagn Interv Radiol

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“…Eiada et al described the appearances of papillomas on mammography, sonography and MRI. 10 On mammography, small papillomas can be occult, particularly when located in the retroareolar regions because of the breast density and relative lack of compression in that area.…”

Section: Discussionmentioning

confidence: 99%

Case series: imaging features of intraductal papillomas in patients presenting as nipple discharge

et al. 2016

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“…Mammography has a low sensitivity and specificity in the diagnosis of papillary lesions since they may be ocult (especially benign papillomas) or may present with discrete or nonspecific findings: area of increased density (micropapillary DCIS), dilated duct (intraductal papilloma or malignancy), or a solitary mass with benign or malignant features [1,5]. Its value consists of depicting the malignant calcifications that can accompany a papillary malignant lesion [5] (fig 1).…”

Section: Mammographymentioning

confidence: 99%

“…Its value consists of depicting the malignant calcifications that can accompany a papillary malignant lesion [5] (fig 1). In the retroareolar region, there are more dilated ducts, one with intraductal proliferation (after excision, pathology revealed an intraductal papilloma).…”

Section: Mammographymentioning

confidence: 99%

Ultrasound in the diagnosis of papillary breast lesions

Ciurea

Calin²,

Ciortea³

et al. 2015

Med Ultrason

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Papillary lesions are defined as an amalgam of various lesions which represent a diagnostic challenge, for both the radiologist and pathologist. They are diagnosed on the basis of a combination of clinical, imaging, and pathological findings and their features carry differing prognostic implications for the affected patients. The aim of this pictorial essay is to review the clinical and pathological findings in papillary breast lesions, to show the advantages and limits of each imaging method in their diagnosis with emphasis on the importance of ultrasound in the differential diagnosis. Also, the spectrum of ultrasound features (conventional, Doppler ultrasound and elastography) of papillary lesions of the breast will be illustrated.

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Papillary Lesions of the Breast: MRI, Ultrasound, and Mammographic Appearances

Abstract: There is a wide spectrum of appearances of papillary lesions of the breast on MRI, ultrasound, and mammography. This variable appearance of papillary lesions makes differentiation of benign from malignant pathologies difficult on imaging, and tissue sampling is usually warranted.

Cited by 126 publications

References 14 publications

Papillary lesions of the breast: imaging findings and diagnostic challenges

Papillary lesions of the breast: imaging findings and diagnostic challenges

Case series: imaging features of intraductal papillomas in patients presenting as nipple discharge

Ultrasound in the diagnosis of papillary breast lesions

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