Papillary Lesions of the Breast With and Without Atypical Ductal Hyperplasia Can We Accurately Predict Benign Behavior From Core Needle Biopsy?

Article (PDF Available)inAmerican Journal of Clinical Pathology 122(3):440-3 · October 2004with217 Reads
DOI: 10.1309/NAPJ-MB0G-XKJC-6PTH · Source: PubMed
Abstract
Evaluation of papillary lesions of the breast can be difficult, and in core needle biopsy specimens, accurate diagnosis is challenging. Initial studies suggested that all papillary lesions revealed by core biopsy required surgical excision. Recent data suggest that only papillary lesions with atypical ductal hyperplasia (ADH) revealed by core biopsy need surgical excision. We evaluated our experience at the University of Washington Medical Center, Seattle, with papillary lesions with and without ADH on core biopsy to determine whether diagnostic accuracy can be achieved. In 51 core biopsy specimens, we evaluated the presence or absence of ADH: 25 were benign papillomas; 26 were papillomas with ADH. Surgical follow-up was available for 36 cases (11 papillomas and 25 papillomas with ADH). Clinical (radiologic) follow-up was available in 5 papilloma cases (average follow-up, 35.6 months). Follow-up revealed that all papillomas on core biopsy were benign. Excisional biopsy revealed ductal carcinoma in situ or invasive carcinoma in 12 (48%) of 25 papillary lesions with ADH. Benign papillomas can be adequately diagnosed with core biopsy. All papillary lesions with ADH require surgical excision owing to the high rate of associated neoplasia.
Anatomic Pathology / PAPILLARY BREAST LESIONS ON CORE BIOPSY
440
Am J Clin Pathol
2004;122:440-443
440 DOI: 10.1309/NAPJMB0GXKJC6PTH
© American Society for Clinical Pathology
Papillary Lesions of the Breast With and Without Atypical
Ductal Hyperplasia
Can We Accurately Predict Benign Behavior From Core Needle
Biopsy?
S. Nicholas Agoff, MD, and Thomas J. Lawton, MD
Key Words: Papillary lesions; Breast; Core needle biopsy
DOI: 10.1309/NAPJMB0GXKJC6PTH
Abstract
Evaluation of papillary lesions of the breast can be
difficult, and in core needle biopsy specimens, accurate
diagnosis is challenging. Initial studies suggested that
all papillary lesions revealed by core biopsy required
surgical excision. Recent data suggest that only
papillary lesions with atypical ductal hyperplasia
(ADH) revealed by core biopsy need surgical excision.
We evaluated our experience at the University of
Washington Medical Center, Seattle, with papillary
lesions with and without ADH on core biopsy to
determine whether diagnostic accuracy can be
achieved. In 51 core biopsy specimens, we evaluated
the presence or absence of ADH: 25 were benign
papillomas; 26 were papillomas with ADH. Surgical
follow-up was available for 36 cases (11 papillomas
and 25 papillomas with ADH). Clinical (radiologic)
follow-up was available in 5 papilloma cases (average
follow-up, 35.6 months). Follow-up revealed that all
papillomas on core biopsy were benign. Excisional
biopsy revealed ductal carcinoma in situ or invasive
carcinoma in 12 (48%) of 25 papillary lesions with
ADH. Benign papillomas can be adequately diagnosed
with core biopsy. All papillary lesions with ADH
require surgical excision owing to the high rate of
associated neoplasia.
The spectrum of papillary lesions of the breast includes
benign papilloma, papilloma with atypical ductal hyperplasia
(ADH), papillary carcinoma in situ, and invasive papillary
carcinoma. The evaluation of papillary lesions of the breast
can be difficult on surgical excision specimens, with the
distinction between a papilloma with ADH and papillary
carcinoma in situ frequently being problematic.
1
With the advent of core needle biopsy, accurate diag-
nosis of benign papillary lesions vs papillary lesions with
ADH or worse has been challenging. Some initial data
suggested that all papillary lesions seen on core biopsy
required follow-up surgical excision to exclude in situ or
invasive carcinoma.
2,3
This idea is supported by the fact that
radiologic imaging, while helpful, cannot reliably distinguish
between benign and potentially malignant papillary lesions
revealed by core biopsy.
2,4,5
More recent data have suggested
that benign papillary lesions can be diagnosed comfortably
by using core biopsy (particularly on larger core samples),
and only papillary lesions with ADH revealed by core biopsy
need surgical excision.
6
Because this area remains controversial, the purpose of
the present study was to evaluate our experience at the
University of Washington Medical Center (UWMC),
Seattle, with papillary lesions revealed by core biopsy to
determine whether diagnostic accuracy can be achieved by
using core biopsy alone.
Materials and Methods
The Department of Pathology files were searched for
papillary lesions of the breast diagnosed at UWMC by using
Anatomic Pathology / ORIGINAL ARTICLE
Am J Clin Pathol
2004;122:440-443 441
441 DOI: 10.1309/NAPJMB0GXKJC6PTH 441
© American Society for Clinical Pathology
core needle biopsy from January 1995 to January 2003. The
core biopsy devices used ranged from 14-gauge
(non–vacuum-assisted) to 11- and, more recently, 9-gauge
vacuum-assisted devices.
During the study period 2,090 breast needle core
biopsy specimens were received, and from those, 51 benign
papillary lesions and papillary lesions with ADH were
retrieved. Six of the biopsy specimens were from outside
consultations (5 papillomas with ADH and 1 benign papil-
loma) with clinical or pathologic follow-up performed at
UWMC. All specimens were fixed in buffered neutral
formalin and embedded in paraffin, from which 4- to 5-µm-
thick sections were cut and stained with H&E. Approxi-
mately 3 to 6 levels were cut on each case, with, at most, 3
blocks per biopsy.
The presence or absence of ADH was evaluated in
each case based on review of all slides by S.N.A. and
T.J.L. The core specimens were reviewed and evaluated
for ADH before review of the excision specimens.
Follow-up data were obtained from the clinical record, the
pathology database, or both. The criteria used for
assessing ADH in a papilloma were similar to those set
forth by Kraus and Neubecker
1
(ie, the presence of hyper-
chromatic nuclei or marked nuclear atypia, cribriform
pattern, absent supporting stroma, and a monotonous cell
population without admixed myoepithelial cells). Clinical
(radiographic) follow-up was considered significant only
if the follow-up period was at least 2 years; otherwise, it
was not included in the analysis. Pathologic follow-up
consisted of surgical excision.
The Fisher exact test with a 2-tailed P value was used to
test for associations between variables. This research was
conducted with approval of the Human Subjects Division at
the University of Washington.
Results
Of the 51 papillary lesions on core biopsy, 25 were
benign papillomas and 26 were papillomas with ADH. The
initial diagnosis was the same as the review diagnosis in each
case. The data are summarized in Table 1 (note that cases
without significant follow-up were not included in Table 1).
Of the benign papillomas Image 1, 16 had significant
follow-up, and all were revealed as benign on excision
A B
Table 1
Clinical and Pathologic Characteristics of Benign Papillomas
and Papillary Lesions With ADH Shown on Core Needle Biopsy
Papilloma Papilloma With
Characteristic (n = 16)
*
ADH (n = 25)
*
Average age (y) 54.5 53.0
Clinical manifestations
Mass 1 6
Clear fluid 1 3
Bloody fluid 1 0
Mammographic findings
Mass 9 16
Calcifications 5 7
FAD 1 0
FAD with calcifications 1 0
Follow-up findings
Benign 16 6
ADH 0 7
DCIS 0 10
Invasive carcinoma 0 2
ADH, atypical ductal hyperplasia; DCIS, ductal carcinoma in situ; FAD, focal
architectural distortion.
*
Cases without significant follow-up were excluded from the analysis.
Image 1 Benign papilloma revealed by core needle biopsy (H&E, A, ×40; B, ×400). Note the prominent stoma, single layer of
epithelial cells, and presence of myoepithelial cells.
Agoff and Lawton / PAPILLARY BREAST LESIONS ON CORE BIOPSY
442
Am J Clin Pathol
2004;122:440-443
442 DOI: 10.1309/NAPJMB0GXKJC6PTH
© American Society for Clinical Pathology
(11 cases) or stable clinically or radiographically (5
cases). The average time for follow-up in the clinical
follow-up cases was 35.6 months (median, 41 months;
range, 24-51 months).
Of the papillary lesions with ADH Image 2, 25 had
significant follow-up (all excisions). Of those, 6 (24%) were
benign, 7 (28%) were papillary lesions with ADH, and 12
(48%) were shown to be ductal carcinoma in situ (10 cases)
or invasive carcinoma (2 cases) on excision. The presence of
ADH on core biopsy was associated significantly with DCIS
or invasive carcinoma on follow-up biopsy (P = .001).
The average age of the patients overall was 53.6 years
(range, 30-83 years). The average age of patients with a
benign papilloma was 54.5 years (range, 31-83 years) and
for patients with a papilloma with ADH, 53.0 years (range,
30-79 years).
Twelve lesions were detected clinically (by the
patient or the physician) as the presence of a palpable
mass (7 cases), clear fluid expressed from the nipple (4
cases), or bloody fluid expressed from the nipple (1 case).
Mammography findings were normal in 3 of the clinically
detected cases.
Mammography detected 47 of the lesions, which were
seen as a mass (25 cases), calcifications (11), a mass with
calcifications (1), a focal architectural distortion (1), or a
focal architectural distortion with calcifications (1). All
lesions detected by mammography were labeled “suspi-
cious” for malignancy.
There were no statistically significant associations
between lesions manifesting as a mass, calcifications, or
expressed fluid and subsequent DCIS or invasive carcinoma
revealed by the excisional biopsy.
Discussion
Papillary lesions of the breast remain a challenging
subject in diagnostic breast pathology, and controversy
remains about whether needle core biopsy is sufficiently
accurate in the diagnosis of benign pathology to avoid
surgical biopsy. Our study indicates that needle core biopsy
is accurate in the diagnosis of benign papillary lesions and
that any ADH in a papillary lesion shown on core needle
biopsy necessitates surgical excision.
The criteria we used in this study were developed in 1962
by Kraus and Neubecker,
1
and those criteria remain valid in the
diagnosis of ADH in papillary lesions. The presence of ADH
in our study was correlated significantly with the presence of
invasive or preinvasive carcinoma of the breast. These findings
are similar to those of Ivan and colleagues,
6
who found that for
63% (5/8) of their papillary lesions with ADH diagnosed on
core biopsy, excisional biopsy revealed carcinoma in situ.
Our study also confirms previous reports that mammog-
raphy is not reliable for the distinction between benign and
atypical papillary lesions. All of the radiologically detected
lesions in our study were designated as suspicious for malig-
nancy on mammography. This is similar to studies by Soo et
al
4
and Woods and colleagues,
5
who found that papillary
carcinoma and solitary breast papillomas can have overlap-
ping features and are difficult to distinguish radiologically.
However, close radiologic follow-up is essential for
benign papillomas because an interval change in the lesion
could predict malignancy. The average clinical follow-up
time in our study for benign papillary lesions shown on core
biopsy was 35.6 months, which compares well with the
established literature but cannot be considered long-term
A B
Image 2 Papilloma with atypical ductal hyperplasia (H&E, A, ×40; B, ×400). The epithelial cell population focally appears more
monomorphic with increased nuclear atypia and a suggestion of cribriform architecture.
Anatomic Pathology / ORIGINAL ARTICLE
Am J Clin Pathol
2004;122:440-443 443
443 DOI: 10.1309/NAPJMB0GXKJC6PTH 443
© American Society for Clinical Pathology
follow-up.
7,8
In the study by Lee and colleagues
8
of 355
lesions with benign core biopsy diagnoses followed by
mammography, mammographic change occurred in 7% of
cases, and malignancy was diagnosed in only 2 cases that
showed change at 6 and 24 months. This study did not
specifically address papillary lesions, however, and addi-
tional studies with longer-term follow-up are needed to
assess the clinical course of benign papillary lesions that are
not excised after core biopsy.
7
At UWMC, core needle biopsies are performed using a
variety of sizes of biopsy devices depending on whether the
core biopsy is performed by a surgeon on a palpable mass or
whether the lesion is localized by ultrasound vs stereotactic
techniques. There is some controversy in the literature about
whether the size of the core biopsy device correlates with
complete evaluation of the lesion and the need for excision.
2,3,6
Our study was designed to look at papillary lesions shown on
core biopsy and does not specifically address this issue.
Our experience at UWMC with core needle biopsy
shows it to be accurate in the distinction between benign
papillomas of the breast and those with malignant potential.
Core needle biopsy is an effective and accurate way to eval-
uate papillary lesions of the breast. However, benign papil-
lomas shown on core needle biopsy still should be followed
up closely clinically and radiologically, and more studies
with long-term follow-up are warranted. Any ADH in papil-
lary lesions shown on core needle biopsy warrants surgical
excision, as a significant proportion of these lesions contain
in situ or invasive carcinoma.
From the Department of Pathology, University of Washington
Medical Center, Seattle.
Address reprint requests to Dr Agoff: Dept of Pathology,
UWMC/Harborview Medical Center, Box 356100, 1959 NE
Pacific St, Seattle, WA 98195.
References
1. Kraus F, Neubecker R. The differential diagnosis of papillary
tumors of the breast. Cancer. 1962;15:444-455.
2. Puglisi F, Zuiani C, Bazzocchi M, et al. Role of mammography,
ultrasound and large core biopsy in the diagnostic evaluation
of papillary breast lesions. Oncology. 2003;65:311-315.
3. Jacobs TW, Connolly JL, Schnitt SJ. Nonmalignant lesions in
breast core needle biopsies: to excise or not to excise? Am J
Surg Pathol. 2002;26:1095-1110.
4. Soo MS, Williford ME, Walsh R, et al. Papillary carcinoma of
the breast: imaging findings. AJR Am J Roentgenol.
1995;164:321-326.
5. Woods ER, Helvie MA, Ikeda DM, et al. Solitary breast
papilloma: comparison of mammographic, galactographic, and
pathologic findings. AJR Am J Roentgenol. 1992;159:487-491.
6. Ivan D, Selinko V, Sahin AA, et al. Accuracy of core needle
biopsy diagnosis in assessing papillary breast lesions: histologic
predictors of malignancy. Mod Pathol. 2004;17:165-171.
7. Liberman L. Percutaneous image-guided core breast biopsy.
Radiol Clin North Am. 2002;40:483-500.
8. Lee CH, Phipotts LE, Horvath LJ, et al. Follow-up of breast
lesions diagnosed as benign with stereotactic core-needle
biopsy: frequency of mammographic change and false-
negative rate. Radiology. 1999;212:189-194.
    • Papillary lesions of the breast have been a manner of challenge for pathologists[2,4,5,11,12,13]. The spectrum consists of benign to malignant neoplasms with papillary features including papilloma, papilloma with atypical ductal hyperplasia, in situ and invasive papillary carcinoma[11]. Papillary carcinoma has well-defined borders and thin finger–like papillary projections which sometimes constitutes solid areas.
    [Show abstract] [Hide abstract] ABSTRACT: Breast cancer constitutes a heterogenous group of lesions. Invasive papillary carcinoma of the breast is a rare form of breast cancer with less aggressive behavior which may have mucinous differentiation. Histologically papillary projections with fibrovascular core and epithelial proliferation are present. Signet ring morphology and extracellular mucin production can be seen but myoepithelial cells are absent. We reported a case of invasive papillary carcinoma of the breast in a 74-year-old lady without mucin production, which first presentation was a metastasis of unknown origin to the spinal column as adenocarcinoma with mucin production. In conclusion, although invasive papillary carcinoma of the breast is known as a less aggressive tumor, but its presentation may be with metastasis and mucin production, despite of non-mucinous primary tumor.
    Full-text · Article · Apr 2017 · Breast Cancer Research and Treatment
    • Several clinical groups argue for an aggressive complete excisional treatment when an intraductal papilloma is diagnosed , going from a tumorectomy whether solitary papillomas to a radical mastectomy in the case of diffuse lesions [11, 12,313233. On the other hand there are works suggesting the treatment of breast intraductal papilloma to be not so invasive and based in a conservative image-controlled follow- up131415 34]. The possibility of making a recommendation for excision only in specific cases where an uncertain degree of malignancy is present is also discussed [35].
    [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 ( P < 0.0001 ) 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.
    Full-text · Article · Oct 2015
    • Central single papillomas have not been considered premalignant or markers of risk when they are not associated with atypia. The presence of atypical ductal hyperplasia within the papilloma is associated to the presence of invasive or preinvasive carcinoma of the breast in excisional biopsies [216,217]. However, epithelial atypia, even to the extent of low-grade DCIS, has no known prognostic significance or impact on outcome when it is confined to the central papilloma.
    [Show abstract] [Hide abstract] ABSTRACT: BBD of the breast are much more common than malignant lesions. The spectrum of Benign breast disease (BBD) includes a large number of physiopathological lesions of the different components of the breast (epithelial, stromal, adipocytes, or vascular). Breast tissue is under a complex system of influence by systemic factors, particularly hormones, as well as a number of local factors. This interrelationship results in different clinical manifestations for which a clear-cut clinical and histopathological separation between the physiologic and pathologic changes may not be always possible. This situation has led to a great deal of confusion, particularly in certain entities, with different nomenclatures for the same lesion , and unfortunately for many of them, the lack of a unique, unequivocal and commonly accepted definition. In the academic field, the consequence of this situation has been that benign breast disorders have been the subject of a relatively few isolated and unconnected studies, frequently ignoring earlier related work. Hence, it is even more difficult, to find in the literature, complete and broad scope data concerning the mechanisms involved in the development of such disorders. From a practical point of view, much of the interest in BBD focuses on its relationship with the subsequent development of carcinoma. Breast lesions that do not increase the risk of breast cancer should be distinguished from those that confer a small or a moderate increase in risk, and this stratification should be reflected in BBD classification. Taking all of this into account, in this chapter, benign lesions of the breast are summarized to include: inflammatory lesions, fibroepithelial lesions, stromal lesions, benign epithelial proliferations/fibrocystic changes, and benign epithelial neoplasms. Finally, the study of BBD with current molecular methodologies suffers from the same limitations stated previously. However some insight in the biology and classification of BBD has been gained through their application. Such evidence is of importance and is commented on each of the sections of this chapter when available.
    Full-text · Chapter · Jan 2014 · Breast Cancer Research and Treatment
    • On the other hand, none of these factors were significantly different in benign papillomas versus malignant papillomas in the aforementioned studies [4, 14,232425262829303132 . These results have led to a preference for excision over follow-up for the management of benign papillomas on CNB [22, 24, 27, 31, 34, 35], whereas follow-up was the preferred management in reports from the late 1990s and early 2000s [7, 9, 14, 20, 21]. This issue is still under considerable debate.
    [Show abstract] [Hide abstract] ABSTRACT: To evaluate whether the upgrade-to-malignancy rate of benign papillary lesions on ultrasonographically (US)-guided 14-gage core needle biopsy (CNB) can be decreased using immunohistochemistry staining (IHC) for pathologic diagnosis, and to determine whether additional IHC can replace surgical excision for the diagnosis of papillary breast lesions classified as benign on 14-gage CNB. A total of 274 consecutive papillary lesions were studied, including available imaging findings, CNB specimens and surgical specimens. Two rounds of retrospective review of the pathologic slides from CNB were performed by a pathologist, including H&E staining (first round; 1R, n = 274) and IHC of the benign papillomas (second round; 2R). The upgrade-to-malignancy rate was assessed for benign papillomas with comparison between 1R and 2R. The final diagnosis was based on surgical pathology. The clinicoradiologic findings were compared between the benign and malignant papillomas at the time of final diagnosis. In 1R, 204 benign papillomas were identified. During 2R using IHC, three carcinomas and ten atypical papillomas were diagnosed. Among the 204 benign papillomas from 1R, 15 were found to be carcinomas (upgrade-to-malignancy rate, 7.4 %) at the time of final diagnosis. With 2R, the overall upgrade-to-malignancy rate was decreased to 4.7 % (9/192, p = 0.3680). Older age and upgrades made after IHC review resulted in higher upgrade-to-malignancy rates (odds ratio, 4.133, 95 % CI 1.393-12.267, p = 0.0106; 134.46, 95 % CI 17.886-infinity, p < 0.0001, respectively). The use of IHC may decrease the upgrade-to-malignancy rate for benign papillary lesions after US-guided 14-gage CNB and help to more accurately predict malignancy at the time of surgery. Despite these findings, a misdiagnosis still occurred in our study, suggesting that IHC cannot replace surgical excision for diagnosis of benign papillary lesions of the breast.
    Full-text · Article · Jan 2013
    • Several studies have focused on the management of benign papillomas diagnosed at core needle biopsy performed under ultrasound or stereotactic guidance, often with needles measuring 14-gauge or smaller [6, 9, 11, 14, 19,232425 (Table 5). A limited number of studies have included papillary lesions found on VAB with larger needles (8-to 11-gauge) [7, 16, 17, 21,262728 (Table 6). No study has focused on the upgrade rate in women with papilloma diagnosed at MRI-guided VAB.
    [Show abstract] [Hide abstract] ABSTRACT: The objective of our study was to determine the frequency of cancer at surgery in breast lesions yielding papilloma at MRI-guided 9-gauge vacuum-assisted biopsy (VAB) and to determine whether any features are associated with cancer upgrade. For this study, 1487 MRI-guided vacuum-assisted biopsies performed from January 2004 to March 2011 were reviewed. Lesions yielding papilloma were identified and classified as papilloma with or without atypia. Surgical findings were reviewed to determine the cancer rate. Statistical analysis was performed and 95% CIs were calculated. Papilloma was identified in 75 of the 1487 MRI-guided vacuum-assisted biopsies (5%). These 75 papillomas occurred in 73 women with a median age of 49 years (age range, 27-70 years). Of the 75 papillomas, 25 (33%) had atypia and 50 (67%) did not on core needle biopsy. Subsequent surgery of 67 of the 75 papillomas (89%) yielded ductal carcinoma in situ (DCIS) in four (6%; 95% CI, 2-15%). Surgery yielded DCIS in two of 23 papillomas with atypia (9%; 95% CI, 1-28%) at MRI-guided VAB and in two of 44 papillomas without atypia (5%; 95% CI, 0.4-16%) at MRI-guided VAB; these cancer rates did not differ significantly (p = 0.6). Postmenopausal status (p = 0.04) and histologic size of less than 0.2 cm (p = 0.04) had a significant association with the cancer upgrade rate. Papilloma with or without atypia was found in 5% of patients who underwent MRI-guided VAB during the study period. Surgery revealed cancer in 6%. DCIS was found at surgery in 9% of lesions yielding papilloma with atypia versus 5% of lesions yielding papilloma without atypia. For lesions yielding papilloma with or without atypia at MRI-guided VAB, surgical excision is warranted.
    Full-text · Article · Oct 2012
    • Four out of these studies, those of Ahmadiyeh, Sydnor, Renshaw and Agoff, each independently concluded that benign papillomas at core biopsy are infrequently associated with malignancy at excision (0–3%) and may be followed clinically and mammographically. Three out of these four studies [2, 3, 5] reported that none of the papillary lesions without atypia were associated with carcinoma. In the paper by Sydnor et al. [4], only 1 out of 13 (3%) excised benign papillomas was upgraded to malignancy at excision.
    [Show abstract] [Hide abstract] ABSTRACT: Our goal was to assess the value of surgical excision of benign papillomas of the breast diagnosed on percutaneous core biopsy by determining the frequency of upgrade to malignancies and high risk lesions on a final surgical pathology. We reviewed 67 patients who had biopsies yielding benign papilloma and underwent subsequent surgical excision. Surgical pathology of the excised lesions was compared with initial core biopsy pathology results. 54 patients had concordant benign core and excisional pathology. Cancer (ductal carcinoma in situ and invasive ductal carcinoma) was diagnosed in five (7%) patients. Surgery revealed high-risk lesions in 8 (12%) patients, including atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ. Cancer and high risk lesions accounted for 13 (19%) upstaging events from benign papilloma diagnosis. Our data suggests that surgical excision is warranted with core pathology of benign papilloma.
    Full-text · Article · Nov 2011
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April 2006 · Radiology · Impact Factor: 6.87
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