Concordant, non-atypical breast papillomas do not require surgical excision: A 10-year multi-institution study and review of the literature

Grimm, Lars J.; Bookhout, Christine; Bentley, Rex C.; Jordan, Sheryl G.; Lawton, Thomas J.

doi:10.1016/j.clinimag.2018.04.021

Cited by 25 publications

(21 citation statements)

References 63 publications

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“…reported serious inconsistencies in the management of these lesions at academic institutions across the United States, with surgical excision rates ranging from 39% to 95% between centers . Several studies advocate radiologic imaging follow‐up for nonatypical papillomas as the malignancy rate of these lesions may be less than 2.5%, whereas others have found that up to 33% of these lesions may prove malignant and therefore recommend complete surgical excision . Considerable variation in the upgrading of flat epithelial atypia, atypical ductal hyperplasia, LCIS/atypical lobular hyperplasia and radial scar to malignancy has been reported (flat epithelial atypia: 0–15%, atypical ductal hyperplasia: 22%–32%, LCIS/atypical lobular hyperplasia: 2%–29%, radial scar: 0%–23%), resulting in mixed recommendations that range from radiologic surveillance to diagnostic surgical excision of every high‐risk lesion .…”

Section: Discussionmentioning

confidence: 99%

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Luiten

Korte

Voogd

et al. 2019

Intl Journal of Cancer

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Between January 1, 2011, and December 31, 2016, we studied the incidence, management and outcome of high‐risk breast lesions in a consecutive series of 376,519 screens of women who received biennial screening mammography. During the 6‐year period covered by the study, the proportion of women who underwent core needle biopsy (CNB) after recall remained fairly stable, ranging from 39.2% to 48.1% (mean: 44.2%, 5,212/11,783), whereas the proportion of high‐risk lesions at CNB (i.e., flat epithelial atypia, atypical ductal hyperplasia, lobular carcinoma in situ and papillary lesions) gradually increased from 3.2% (25/775) in 2011 to 9.5% (86/901) in 2016 (p < 0.001). The mean proportion of high‐risk lesions at CNB that were subsequently treated with diagnostic surgical excision was 51.4% (169/329) and varied between 41.0% and 64.3% through the years, but the excision rate for high‐risk lesions per 1,000 screens and per 100 recalls increased from 0.25 (2011) to 0.70 (2016; p < 0.001) and from 0.81 (2011) to 2.50 (2016; p < 0.001), respectively. The proportion of all diagnostic surgical excisions showing in situ or invasive breast cancer was 29.0% (49/169) and varied from 22.2% (8/36) in 2014 to 38.5% (5/13) in 2011. In conclusion, the proportion of high‐risk lesions at CNB tripled in a 6‐year period, with a concomitant increased excision rate for these lesions. As the proportion of surgical excisions showing in situ or invasive breast cancer did not increase, a rising number of screened women underwent invasive surgical excision with benign outcome.

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Section: Discussionmentioning

confidence: 99%

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Luiten

Korte

Voogd

et al. 2019

Intl Journal of Cancer

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“…Due to the lack of reliable clinical and imaging features predictive of upgrade, the management of BPs without atypia diagnosed on CNB remains controversial. Among studies with large sample sizes (150-388 cases), the upgrade rates to malignancy ranged from 0% to 12%, leading to divergent recommendations [6,8,10,13]. The 612 BPs in our study comprise to our knowledge the largest cohort to date, which should reduce the results' margin of error.…”

Section: Discussionmentioning

confidence: 87%

“…A N U S C R I P T controversial, and an evidence-based standard of care is elusive [5]. The reported upgrade rates to malignancy among BPs vary widely from 0% to 33% [6][7][8][9][10][11][12]. Comparison of results is hampered by these studies' heterogeneity in sample size, inclusion/exclusion of atypical papillomas, inclusion/exclusion of patients with a history of breast cancer, biopsy technique, as well as method and length of follow-up.…”

Section: A C C E P T E D Mmentioning

confidence: 99%

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Analysis of 612 Benign Papillomas Diagnosed at Core Biopsy: Rate of Upgrade to Malignancy, Factors Associated With Upgrade, and a Proposal for Selective Surgical Excision

Lee

Wahab

Sobel

et al. 2021

American Journal of Roentgenology

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The publication of this Accepted Manuscript is provided to give early visibility to the contents of the article, which will undergo additional copyediting, typesetting, and review before it is published in its final form. During the production process, errors may be discovered that could affect the content of the Accepted Manuscript. All legal disclaimers that apply to the journal pertain. The reader is cautioned to consult the definitive version of record before relying on the contents of this document.

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“…The published literature supporting their excision reports upgrade rates of 0% to 29% [7]. On the other hand, several authors report either no or minimal upgrade rate and recommend follow-up rather than excision [8]. The decision to evade or pursue surgical excision is crucial as an unwarranted excision leads to potential morbidity and increases healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Non-Malignant Papillary Lesions of the Breast on Core Biopsy: An Experience from a Tertiary Care Center in Pakistan

Fatima¹,

Afzal²,

Tariq³

2020

Cureus

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Background Papillary lesions of the breast constitute a heterogeneous group ranging from non-malignant papillomas to papillary carcinoma. While surgical excision is recommended for atypical papilloma or papillary DCIS/ carcinoma on core biopsy, controversy persists in the management of benign papillomas which are diagnosed with core needle biopsy (CNB) since there are variable reported rates for tumor upgrade. The purpose of this study was to determine the outcome of papillary lesions of the breast diagnosed at image-guided CNB, after surgical excision or follow-up, and to identify potential predictors of high-risk lesions/malignancy on imaging.

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Concordant, non-atypical breast papillomas do not require surgical excision: A 10-year multi-institution study and review of the literature

Cited by 25 publications

References 63 publications

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Analysis of 612 Benign Papillomas Diagnosed at Core Biopsy: Rate of Upgrade to Malignancy, Factors Associated With Upgrade, and a Proposal for Selective Surgical Excision

Outcome of Non-Malignant Papillary Lesions of the Breast on Core Biopsy: An Experience from a Tertiary Care Center in Pakistan

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