An International Multicenter Review of the Malignancy Rate of Excised Papillomatous Breast Lesions

Foley, Niamh; Racz, Jennifer M.; Al‐Hilli, Zahraa; Livingstone, Vicki; Cil, Tulin; Holloway, Claire; Romics, László; Mátrai, Zoltán; Bennett, Michael; Duddy, Lorna; Nofech‐Mozes, Sharon; Slodkowska, Elzbieta; Mallon, Elizabeth; Dawson, Nicola C.; Roche, T.; Relihan, N.; Hill, Arnold D.; Redmond, H. P.; Corrigan, Mark

doi:10.1245/s10434-015-4773-z

Cited by 31 publications

(23 citation statements)

References 28 publications

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“…The role of atypical growths as the most important predictive factors for a malignant process was also emphasized in the meta-analysis by Wen [21], or later works by Shiino, Han, Kiran, Boufelli or Foley [12,[23][24][25]30]. Current recommendations on diagnostic-therapeutic management still advise radical surgical approach in IPs with atypia, regardless of the biopsy technique [31].…”

Section: Discussionmentioning

confidence: 99%

Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy

et al. 2019

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Objectives: The aims of the study were as follows: 1) to determine the applicability of vacuum-assisted core needle biopsy in the diagnosis and management of intraductal papillomas of the breast; 2) to define factors which increase the risk for underestimation of breast cancer. Material and methods: Between 2002-2017, a total of 222 cases of intraductal papillomas were diagnosed in one center (201 using vacuum-assisted core-needle ultrasound-guided biopsy and 21 using stereotactic biopsy). All patients underwent scheduled follow-up imaging. Results: Pure papillomas were diagnosed in 158 women, whereas papillomas with atypia, in this case atypical ductal hyperplasia (ADH), were found in 29 subjects. In the latter group, 3 cases of invasive carcinoma and 5 cases of ductal carcinoma in situ (DCIS) were detected using open surgical biopsy. Breast cancer underestimation in that group of patients was 20%. Overall, ADH, whose presence increases the risk for BC by thirteen-fold as compared to other accompanying lesions, proved to be the most important predictive factor. Also, age, non-radical biopsy excision, and high BI-RADS ultrasound and mammogram scores increased the probability of malignancy. During the control follow-up, no cases of IP recurrence in the primary localization were observed in the group without open surgical biopsy. Conclusions: Vacuum-assisted core needle biopsy is an efficient tool in the diagnosis and management of intraductal papillomas of the breast. Surgical excision is not indicated in cases when a pure intraductal papilloma, and data correlation between the diagnosis and the clinical presentation were confirmed. Regardless, caution is advised if residual lesions were left and in older populations. Open surgical biopsy should remain the standard of care in cases with atypia and discordance between clinical and pathology data.

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Section: Discussionmentioning

confidence: 99%

Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy

et al. 2019

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“…cancer after surgical excision (45,46). Therefore, surgical management or radiologic follow-up is often recommended.…”

Section: Intraductal Papillary Lesionmentioning

confidence: 99%

Automated Three-dimensional Breast US for Screening: Technique, Artifacts, and Lesion Characterization

Zelst¹,

Mann²

2018

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Automated breast (AB) ultrasonography (US) scanners have recently been brought to market for breast imaging. AB US devices use mechanically driven wide linear-array transducers that can image whole-breast US volumes in three dimensions. AB US is proposed for screening as a supplemental modality to mammography in women with dense breasts and overcomes important limitations of whole-breast US using handheld devices, such as operator dependence and limited reproducibility. A literature review of supplemental whole-breast US for screening was performed, which showed that both AB US and handheld US allow detection of mammographically negative early-stage invasive breast cancers but also increase the false-positive recall rate. Technicians with limited training can perform AB US; nevertheless, there is a learning curve for acquiring optimal images. Proper acquisition technique may allow avoidance of common artifacts that could impair interpretation of AB US results. Regardless, interpretation of AB US results can be challenging. This article reviews the US appearance of common benign and malignant lesions and presents examples of false-positive and false-negative AB US results. In situ breast cancers are rarely detected with supplemental whole-breast US. The most discriminating feature that separates AB US from handheld US is the retraction phenomenon on coronal reformatted images. The retraction phenomenon is rarely seen with benign findings but accompanies almost all breast cancers. In conclusion, women with dense breasts may benefit from supplemental AB US examinations. Understanding the pitfalls in acquisition technique and lesion interpretation, both of which can lead to false-positive recalls, might reduce the potential harm of performing supplemental AB US. Online supplemental material is available for this article. RSNA, 2018.

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“…Once a papillary lesion is diagnosed in percutaneous needle biopsy, the current recommendation is surgical excision, on the basis of the risk of underestimation for carcinoma, which can be up to 25%. The distinction between benign and malignant lesions through percutaneous needle biopsy can be difficult, especially in cases with limited material and with discontinuous fragments ( Ueng et al , 2009 ; Lu et al , 2012 ; Foley et al , 2015 ).…”

Section: Introductionmentioning

confidence: 99%

“…Papillary lesions may have many different presentations such as nipple discharge, palpable breast mass, or breast-imaging study finding. Consequently, they can have different image presentations, such as a circumscribed lump, an irregular lump, or a dilated duct in the retroareolar region ( Ohuchi et al , 1984 ; Ali-Fehmi et al , 2003 ; Lewis et al , 2006 ; Ueng et al , 2009 ; Jagmohan et al , 2013 ; Foley et al , 2015 ). The correlation between clinical and imaging findings with the histopathological diagnosis of the surgical specimen is yet to be determined ( Ueng et al , 2009 ).…”

Section: Introductionmentioning

confidence: 99%

Papillomas of the breast: factors associated with underestimation

Boufelli¹,

Giannotti

Ruíz³

et al. 2018

European Journal of Cancer Prevention

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The distinction between benign and malignant papilloma of the breast through percutaneous needle biopsy can be difficult because of limited samples; the underestimation rate can be up to 25%. The aim of this study is to identify clinical and histological factors associated with underestimation, invasive ductal carcinoma, or ductal in-situ carcinoma (DCIS) of the breast found in surgical specimens from papillary lesions. This may contribute toward selection of patients for a follow-up strategy without the need for surgical excision. From a database of 3563 patients, we identified 85 with intraductal papilloma between 2007 and 2013 who had undergone breast-imaging studies, percutaneous needle biopsy, and surgical resection of the lesion. Central papillomas normally present with a palpable mass, whereas peripheral papillomas generally do not have clinical manifestations (microcalcifications); both central and peripheral papillomas were related to atypical lesions, 13.5 and 15.4%, respectively. Among the 59 cases of central papillomas, there were four cases of underestimation, three DCIS and one invasive ductal carcinoma (6.8%). Among the 26 cases of peripheral papillomas, there was one case of DCIS (3.8%), with a total underestimation rate of 5.8%; all underestimated lesions measured more than 1 cm. The median size was 11 mm at mammography and 19 mm at ultrasound. Our data suggest that lesions less than 1 cm in size, without atypia and concordant imaging and clinical findings, may not require surgical resection.

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An International Multicenter Review of the Malignancy Rate of Excised Papillomatous Breast Lesions

Cited by 31 publications

References 28 publications

Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy

Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy

Automated Three-dimensional Breast US for Screening: Technique, Artifacts, and Lesion Characterization

Papillomas of the breast: factors associated with underestimation

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