Intraductal papilloma (IDP) is well-known as one of the common benign breast lesions requiring excision. However, treatment of IDP without atypia is controversial. The aim of our study was to determine the proper management of solitary IDP by core needle biopsy (CNB).
Patients and Methods
We retrospectively reviewed patients with solitary IDP confirmed by CNB from March 2003 to March 2015. We collected data about final pathology after excision, as well as clinical, histologic, and radiologic findings at initial diagnosis. The final pathology was categorized as benign or malignant. We evaluated the rate of upgrade to malignancy and factors associated with malignancy.
We identified 405 patients who presented benign solitary IDP by CNB. The mean age was 46.1 years (range, 15-86 years). In total, 135 patients underwent surgical excision, and 211 underwent vacuum-assisted excision. Of 346 patients, malignant lesions were found in 8 patients (2.3%): 7 underwent surgical excision, and 1 underwent vacuum-assisted excision. Only the size of IDP was significantly associated with cancer upgrade (P = .003).
Our study shows that overall malignancy upgrade rate of benign solitary IDP after excision is very low (2.3%). Even when the size of IDP was less than 1 cm, the upgrade rate to cancer was only 0.9%. Therefore, for patients with small solitary IDP, we recommend close follow-up with ultrasound instead of excision.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Clinical Breast Cancer
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Papillary lesions: a review of the literature.Ann Surg Oncol. 2007; 14: 1009-1013
- Papilloma on core biopsy: excision vs. observation.Ann Surg Oncol. 2014; 22: 1-4
- Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up.J Am Coll Surg. 2012; 214: 280-287
- Management of intraductal papillomas of the breast: an analysis of 129 cases and their outcome.Ann Surg Oncol. 2009; 16: 2264-2269
- Papillary lesions of the breast at percutaneous core-needle biopsy.Radiology. 2006; 238: 801-808
- Surgical and mammographic follow-up of papillary lesions and atypical lobular hyperplasia diagnosed with stereotactic vacuum-assisted biopsy.Breast J. 2002; 8: 230-233
- Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy.Cancer. 2009; 115: 2837-2843
- Management of ultrasonographically detected benign papillomas of the breast at core needle biopsy.AJR Am J Roentgenol. 2011; 196: 723-729
- Intraductal papilloma with benign pathology on breast core biopsy: to excise or not?.Ann Surg Oncol. 2016; 23: 1-7
- Management of benign intraductal solitary papilloma diagnosed on core needle biopsy.Ann Surg Oncol. 2013; 20: 1900-1905
- Benign papillomas without atypia diagnosed on core needle biopsy: experience from a single institution and proposed criteria for excision.Clin Breast Cancer. 2013; 13: 439-449
- Ultrasound-guided vacuum-assisted core breast biopsy: experience with 406 cases.Breast Cancer Res Treat. 2007; 102: 103-110
- Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience.Clin Radiol. 2009; 64: 801-806
- Benign papilloma without atypia diagnosed at US-guided 14-gauge core-needle biopsy: clinical and US features predictive of upgrade to malignancy.Radiology. 2011; 258: 81-88
- Asymptomatic benign papilloma without atypia diagnosed at ultrasonography-guided 14-gauge core needle biopsy: which subgroup can be managed by observation.Ann Surg Oncol. 2016; 23: 1860-1866
- Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies: rate of upgrade to carcinoma at excision.Cancer. 2016; 122: 2819-2827
- Microcalcification is an important factor in the management of breast intraductal papillomas diagnosed on core biopsy.Am J Clin Pathol. 2012; 138: 789-795
- Risk factors for malignancy in benign papillomas of the breast on core needle biopsy.World J Surg. 2010; 34: 261-265
- Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study.Eur Radiol. 2010; 20: 1093-1100
- Papillary lesions initially diagnosed at ultrasound-guided vacuum-assisted breast biopsy: rate of malignancy based on subsequent surgical excision.Ann Surg Oncol. 2011; 18: 2506-2514
- Papillary lesions of the breast: impact of breast pathology subspecialization on core biopsy and excision diagnoses.Am J Surg Pathol. 2012; 36: 544-551
Published online: March 31, 2017
Accepted: March 23, 2017
Received in revised form: March 14, 2017
Received: December 4, 2016
© 2017 Elsevier Inc. All rights reserved.