Papilloma on Core Biopsy: Excision vs. Observation

Nakhlis, Faina; Ahmadiyeh, Nasim; Lester, Susan C.; Raza, Sughra; Lotfi, Parisa; Golshan, Mehra

doi:10.1245/s10434-014-4091-x

Cited by 46 publications

(30 citation statements)

References 10 publications

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“…Nakhlis at el. 10 observed no upgrades at EXC of IDPs in radiologic-pathologic concordant CNB samples, that were evaluated by an expert breast pathologist. Taken together, our results show that the risk of carcinoma associated with IDP diagnoses in radiologic-pathologic concordant CNB is low.…”

Section: Discussionmentioning

confidence: 85%

“…However, most of the published series did not take into account radiologic-pathologic concordance of the lesions 10 , which may lead to falsely high upgrade rates. 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 .…”

Section: Introductionmentioning

confidence: 99%

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

Pareja

Corben

Brennan

et al. 2016

Cancer

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Background The surgical management of breast intraductal papilloma without atypia (IDP) identified at core needle biopsy (CNB) is controversial. We assessed the rate of upgrade to carcinoma at surgical excision, and identified parameters predictive of upgrade. Methods We identified women with CNB diagnosis of intraductal papilloma without atypia or carcinoma at our center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. We correlated the radiologic and clinicopathologic features of patients with CNB diagnosis of IDP with upgrade to carcinoma at surgical excision. Results Our study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent excision. The upgrade rate was 2.3% (4/171). The upgrade lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥8 mm away. Twenty-four women (25 IDPs) did not undergo excision, and had stable imaging at follow-up (median of 23.5 months). Conclusions The upgrade rate at excision of IDP diagnosed at CNB with radiologic-pathologic concordance is 2.3%. Our findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

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

Pareja

Corben

Brennan

et al. 2016

Cancer

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“…However, doubts have been raised that surgical treatment is necessary for all patients with BPLs [4567]. Many previous studies have attempted to determine the necessity of surgical treatment in patients with IDP [2678]. In fact, the upgrade rate of BPLs is the most accurate way to compare the results before and after a surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

“…However, only a few studies fulfill the necessary conditions. In several small case studies comparing surgical results, 0% to 19% of BPLs were upgraded to malignancy [5679]. …”

Section: Introductionmentioning

confidence: 99%

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Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy

et al. 2016

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PurposeIntraductal papilloma (IDP) is a benign breast disease with malignant potential, for which complete surgical excision is usually recommended. The aim of the present study was to investigate predictive factors for upgrading patients with a benign papillary lesion (BPL).MethodsThis study was an observational study using a prospectively collected cohort. In total, 13,049 patients who underwent a core needle biopsy (CNB) for a breast lesion between January 2009 and May 2015 were enrolled. We reviewed all patients with pathologically confirmed BPL from a CNB.ResultsSurgical treatment was performed for 363 out of a total of 592 lesions. According to the pathological differences, the lowest upgrade rate was shown in IDP without atypia (without atypia, 6.0%; with atypia, 26.8%; papillary neoplasm, 31.5%; p<0.001). The univariate analysis showed that, in IDP without atypia, the age at diagnosis, size of BPL on ultrasonography, and density on mammography were associated with upgrading. The multivariate analysis revealed that age >54 years and lesion size >1 cm were significantly associated with upgrade to malignancy (odds ratio [OR]=4.351, p=0.005 and OR=4.236, p=0.001, respectively).ConclusionThe indications for surgical treatment can be defined as age >54 years and mass size >1 cm, even in IDP without atypia in the CNB results; this also includes cases of IDP with atypia or papillary neoplasm. Therefore, we suggest that close observation without surgery is sufficient for younger women with a small IDP without atypia.

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A retrospective observational study of intraductal breast papilloma and its coexisting lesions: A real‐world experience

Wang

Sun

et al. 2020

Cancer Medicine

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Papilloma on Core Biopsy: Excision vs. Observation

Cited by 46 publications

References 10 publications

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

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

Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy

A retrospective observational study of intraductal breast papilloma and its coexisting lesions: A real‐world experience

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