Excision Is Indicated for Intraductal Papilloma of the Breast Diagnosed on Core Needle Biopsy

Department of Pathology, Mount Sinai Medical Center, New York, New York 10029, USA.
Cancer (Impact Factor: 4.89). 07/2009; 115(13):2837-43. DOI: 10.1002/cncr.24321
Source: PubMed


Although it has been accepted that intraductal papillomas with atypia or malignancy diagnosed on core needle biopsy require surgical excision, the management of pure intraductal papillomas has been controversial. Because some series reported a small but definite incidence of atypia or malignancy, whereas others claimed that radiologic follow-up was adequate, this study evaluated results of excision of all pure intraductal papillomas diagnosed on core needle biopsy at this institution.
By using computerized pathology files from January of 2000 to December of 2004, 200 cases of intraductal papillomas on core needle biopsy were identified. Information regarding excision was available in 104 cases. All specimens were reviewed to confirm both the diagnoses as well as the presence of biopsy site changes in excision specimens, and the findings were correlated with radiologic data.
The age of the patients ranged from 25 to 82 years (mean, 55.5). The diagnoses on excision were as follows: intraductal papillomas = 71 cases (68.3%), no residual intraductal papillomas = 16 (15.3%), atypical duct hyperplasia = 8 (7.7%), ductal carcinoma in situ = 6 (5.8%), and invasive carcinoma = 3 (2.9%). In cases with atypia or malignancy, these findings were adjacent to but not in the biopsy site. In cases with atypical duct hyperplasia or ductal carcinoma in situ, a spectrum of histologic changes ranging from florid to atypical duct hyperplasia (14 cases), to ductal carcinoma in situ (6 cases) were present, all involving intraductal papillomas.
The upstage rate of pure intraductal papillomas on core needle biopsy to atypia or malignancy on excision was 16.4%. Because of sampling error and the close proximity of atypia or malignancy to the intraductal papillomas (suggesting precancerous potential), excision was recommended of these lesions diagnosed on core needle biopsy. Close radiologic-pathologic correlation was important in the evaluation of these lesions.

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Available from: Ira J Bleiweiss, Nov 27, 2015
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    • "15,16 TABLE 4 Previously published papers larger case series ! Paper Year Rizzo et al. 24 2013 Fu et al. 22 2012 Ahmadiyeh et al. 27 2009 Jaffer et al. 28 2009 Cheng et al. 20 2009 MacGrogan et al. 25 2003 Sohn et al. 29 Jakate et al. 15 Glenn et al. 19 There is considerable debate as to the optimal management of breast papillomas with benign pathology on core needle biopsy. Disparate reports exist throughout the literature of the upgrade rates from benign papillomas on core biopsy to malignancy on the final pathology. "
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    ABSTRACT: Papillary lesions of the breast are a relatively rare, but heterogeneous group ranging from benign to atypical and malignant. Debate exists regarding the optimal management of these lesions. In the absence of more accurate risk-stratification models, traditional management guidelines recommend surgical excision, despite the majority of lesions proving benign. This study sought to determine the rate of malignancy in excised breast papillomas and to elucidate whether there exists a population in which surgical excision may be unnecessary. A multicenter international retrospective review of core biopsy diagnosed breast papillomas and papillary lesions was performed between 2009 and 2013, following institutional ethical approval. Patient demographics, histopathological, and radiological findings were recorded. All data was tabulated, and statistical analysis performed using Stata. A total of 238 patients were included in the final analysis. The age profile of those with benign pathology was significantly younger than those with malignant pathology (p < 0.001). Atypia on core needle biopsy was significantly associated with a final pathological diagnosis of malignancy (OR = 2.73). The upgrade rate from benign core needle biopsy to malignancy on the final pathological sample was 14.4 %; however, only 3.7 % had invasive cancer. This international dataset is one of the largest in the published literature relating to breast papillomas. The overall risk of malignancy is significantly associated with older age and the presence of atypia on core needle biopsy. It may be possible to stratify higher-risk patients according to age and core needle biopsy findings, thereby avoiding surgery on low-risk patients.
    Full-text · Article · Aug 2015 · Annals of Surgical Oncology
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    • "[46] 234 olguluk serilerinde, eksizyon sonrası %17,9 ADH, %8,1 DKİS ve %0,9 invaziv duktal karsinom saptamışlardır. Bu nedenle bazı araştırıcılar tüm papiller lezyonlarda eksizyon önermektedir [49]. Diğer taraftan kor biyopside benign papillom tanısı gelen olgularda, görüntüleme bulgularıyla uyumlu ise eksizyon yerine takip öneren çalışmalar mevcuttur [11] [50]. "

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    • "Therefore, excision is always warranted if the diagnosis is made preoperatively by ductal cytology, fine needle aspiration, or core biopsy. Treatment consists of excisional biopsy of the mass along with the central duct from which the drainage occurs [14]. Given the relatively low morbidity associated with excisional biopsy, which can easily be accomplished with minimal intravenous sedation or only local anesthesia in selected adolescent patients, the authors would recommend excision of all suspicious unilateral breast masses in male adolescents. "
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    ABSTRACT: Breast masses presenting in adolescent boys are rare and are almost uniformly owing to gynecomastia. Although surgical referral for breast masses in adolescent boys is common, intervention is typically for cosmesis. We report the case of a 14-year-old boy who presented with an enlarging unilateral breast mass, which was found to be owing to an intraductal papilloma at the time of surgical excision.
    Full-text · Article · May 2011 · Journal of Pediatric Surgery
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