Debate continues regarding the use of surgical excision in benign papillary lesions initially diagnosed at core biopsy. The objective of this study is to propose management guidelines for benign papillary breast lesions initially diagnosed at core biopsy. Between January 2003 and January 2006, 76 lesions were identified as benign papillary lesions at initial core needle biopsy (n=68) or vacuum biopsy (n=8). After surgical excision, six of the 68 benign papillary lesions initially diagnosed at core needle biopsy were confirmed as malignant papillary neoplasms, giving a false-negative rate of core needle biopsy of 8.8%. Three of the eight atypical papillomas initially diagnosed at core needle biopsy were confirmed as papillary cancer in final pathology, giving a false-negative rate of 37.5%. In the analysis of the difference between benign papillary lesions and atypia or malignant papillary lesions, malignant papillary lesions were located more peripherally (p=0.005) than benign lesions and were larger (>1.5 cm, p=0.017). It is concluded that atypical papillomas at initial core biopsy or large, clinically peripherally located papillomas (>1.5 cm) need additional surgical excision.
"This marker combined with other prognostic events such as size larger than 1.5 cm, location , or presence of microcalcifications  can assist when deciding the possibility of an aggressive treatment versus a conservative follow-up. In any case, the absence of COL11A1 in a biopsy can predict with a high probability that an intraductal papilloma will present a benign behavior since it presents a recurrence HR value of 0.0793 (0.02–0.26), although changing in therapeutic behavior seems complicated without further studies. "
[Show abstract][Hide abstract] ABSTRACT: Despite the progress achieved in the treatment of breast cancer, there are still many unsolved clinical issues, being the diagnosis, prognosis, and treatment of papillary diseases, one of the highest challenges. Because of its unpredictable clinical behavior, treatment of intraductal papilloma has generated a great controversy. Even though considered as a benign lesion, it presents high rate of malignant recurrence. This is the reason why there are clinicians supporting a complete excision of the lesion, while others support an only expectant follow-up. Previous results of our group suggested that procollagen 11 alpha 1 (pro-COL11A1) expression correlates with infiltrating phenotype in breast lesions. We analyzed the correlation between expression of pro-COL11A1 in intraductal papilloma and their risk of malignant recurrence. Immunohistochemistry of pro-COL11A1 was performed in 62 samples of intraductal papilloma. Ten out 11 cases relapsed as carcinoma presents positive staining for COL11A1, while just 17 out of 51 cases with benign behaviour present immunostaining. There were significant differences (
) when comparing patients with malignant recurrence versus nonmalignant relapse patients. These data suggest that pro-COL11A1 expression is a highly sensitive biomarker to predict malignant relapse of intraductal papilloma and it can be used as indicative factor for prevention programs.
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