Papillary Lesions of the Breast: Outcomes of 156 Patients Managed without Excisional Biopsy

Abstract

Papillomas of the breast are benign epithelial neoplasms. Because of the low, but continued potential for malignancy, the treatment options after initial diagnosis remain controversial. The aim of this study was to analyze the clinical course of patients with papilloma who were managed by active surveillance following initial diagnosis by core needle biopsy or vacuum-assisted biopsy. This retrospective study analyzed 174 patients with 180 papillomas that were diagnosed by core needle biopsy (113 cases) or vacuum-assisted biopsy (67 cases) at the Breast Center Seefeld Zurich between February 2002 and May 2011. We excluded 24 cases that underwent excisional biopsy for removal of the lesion. Over a mean follow-up of 3.5 years, 13 further events occurred in 156 cases (8%). These events included two cases of ductal carcinoma in situ (one after 4 and one after 6 years), one case of atypical ductal hyperplasia, one radial scar, eight cases of papilloma, and one case of flat epithelial atypia. No invasive carcinomas occurred during the follow-up period. Conservative management of 156 papillary lesions with removal by vacuum-assisted biopsy and surveillance was not associated with invasive cancer over a median follow-up of 3.5 years. Therefore, this approach seems to be a safe option for the clinical management of papillary lesions.

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

“…Most studies following up VAB excision of PL without atypia did not observe any upgrade to malignancy with at least 2 years of surveillance [60, 62, 63]. One recorded a minimal underestimation of 1.4 % [64] and another 3.2 % [65]. …”

Outcomes of benign breast papillomas diagnosed at image-guided vacuum-assisted core needle biopsy

“…Liberman et al [22] reported that of two upgrades, one was after a biopsy for calcifications while the other one was after biopsy of a mass. The sole upgraded case reported by Wyss et al [49] was after an initial stereotactic biopsy of calcifications. All cases upgraded in our series were associated with calcifications on imaging.…”

Treatment and Outcome of 341 Papillary Breast Lesions

“…Given that VAB is less invasive, less expensive and quicker to perform, it may be preferred over open biopsy, which is the current gold standard in treating papillary lesions 4 . At our institution, we are experienced in using VAB to treat selective small benign breast tumors (B2 cm).…”

“…The diagnosis and treatment of papillary lesions is greatly challenging. Papillomas are usually detected by mammography and ultrasound (US) and subsequently diagnosed by fine needle aspiration (FNA), core needle biopsy (CNB) and vacuum-assisted biopsy (VAB) [4]. Although imaging-guided CNB is a reliable method for the diagnosis of breast lesions, papillary lesions identified at percutaneous biopsy can be difficult to interpret histologically [5].…”