Management of intraductal papilloma without atypia of the breast diagnosed on core biopsy: Size and sampling matter

Symbol, Brittany; Ricci, Andrew

doi:10.1111/tbj.13052

Cited by 10 publications

(6 citation statements)

References 18 publications

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“…In a separate investigation involving 520 cases, a lesion size of 1.5 cm on imaging was identified as an independent predictor of malignancy [15]. Another study indicated an increased likelihood of atypia when the lesion size exceeded 1.2 cm [16]. Jaffer et al [17] reported no instances of upgrade in 46 patients diagnosed with IDP lesions smaller than 2 mm.…”

Section: Discussionmentioning

confidence: 97%

Rates of upgrade to malignancy in surgical excision of intraductal papillomas of the breast: A retrospective cohort study

Ünal Özdemir

2023

J Surg Med

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Background/Aim: Intraductal papillomas (IDP) of the breast, though benign, share an association with the duct epithelium, similar to some breast malignancies. Percutaneous biopsies often fail to fully characterize these lesions. The decision to perform surgical excision for IDP of the breast is frequently based on the presence of atypia observed during percutaneous biopsy. However, consensus remains lacking regarding the management of IDP of the breast without atypia. This study was undertaken to share findings on IDP, contributing to a better understanding of their nature and guiding treatment approaches. Methods: We conducted a retrospective evaluation of data from 42 female patients diagnosed with intraductal papilloma through percutaneous biopsy, who subsequently underwent surgical excision between January 1, 2015, and August 25, 2023. Patients not diagnosed with intraductal papilloma, those with prior breast malignancy diagnoses, and those identified incidentally during other surgical procedures were excluded from the study. Data recorded included patient ages, the largest lesion diameters measured by ultrasonography, the percutaneous biopsy method (Fine needle aspiration biopsy [FNAB] or Core needle biopsy [CNB]), atypia status observed during percutaneous biopsy, histopathological features observed during surgical excision, and lesion diameter in cases where malignancy was upgraded. If ductal carcinoma in situ (DCIS) or invasive cancer was identified in the surgical excision specimen, it was classified as an upgrade. Results: The median age of the patients was 48.5 years (range: 12.9 years). FNAB was performed in ten cases (23.8%), while CNB was used in 32 cases (76.2%). There was no significant difference in the detection of atypia when comparing FNAB and CNB (P=0.57). Eight patients (19%) were diagnosed with atypical intraductal papilloma. Among them, three patients with atypia and two patients without atypia exhibited an upgrade to malignancy. The study revealed a malignancy upgrade rate of 37.5% for IDP with atypia and 5.9% for those without atypia. Furthermore, the average age of patients with malignancy upgrades was higher than that of patients with benign lesions (P=0.02). Conclusion: In light of the malignancies detected in cases of breast IDP, even in the absence of atypia, opting for surgical excision, particularly in older patients, can help prevent the oversight of these cancers.

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Section: Discussionmentioning

confidence: 97%

Rates of upgrade to malignancy in surgical excision of intraductal papillomas of the breast: A retrospective cohort study

Ünal Özdemir

2023

J Surg Med

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“…Of the 234 patients diagnosed with IDP without atypia, upgrade-related factors were age (>54 years) and mass size (>1 cm). Recent studies also proposed lesion size from >1 cm to >1.5 cm as a potential predictive factor [13,14,29]. Other factors such as prior breast atypia or cancer history, palpability, peripheral location and radiological-pathological discordance have also been evaluated, but discrepancy among study results has been observed.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies advocated immediate excision due to the significant upgrade rate to cancer from benign IDP after surgery or during follow-up [6][7][8][9][10][11][12]. In recent studies, close surveillance rather than surgery may be considered in the subgroup of patients, with small lesion size [13,14], non-palpability [15], radiological-pathological concordance [14,15], or no personal history of breast cancer [16]. The rationale for close observation in patients with CNB-confirmed IDP is the low upgrade rate to malignancy at the time of surgery [13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Excision Can Be Delayed until Size Grows in Small Papillary Lesions of the Breast

et al. 2020

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The management of intraductal papilloma (IDP) without atypia remains controversial. This study evaluated the manifestations and incidence of malignancy during observation without surgery in patients diagnosed with IDP by core needle biopsy (CNB), to confirm whether close follow-up instead of surgical treatment is the preferred treatment option in selected patients. Methods: We retrospectively reviewed the data of 589 patients diagnosed with IDP by CNB between January 2009 to December 2018. The data of the 102 IDP lesions from 90 women who did not undergo immediate excision were analyzed. Of these, 84 patients received imaging follow-up without excision, while 18 patients underwent delayed excision during follow-up. Results: During the median follow-up period of 18.6 months, the mean change in tumor size and mean percent change in tumor size were −0.06 cm and −0.22%, respectively. Delayed excision was performed in 18 patients (17.6%). In the delayed excision group, three (16.7%) patients and one (5.6%) patient were diagnosed with atypical papilloma and intraductal papillary carcinoma, respectively, based on the final pathological findings. The upstaged group (atypia and malignancy; four patients) showed a 62.0% increase in the tumor size, which is higher than the benign group that showed a 10.4% increase in tumor size. However, the difference was not statistically significant (p= 0.185). Conclusion: Observation without excision is possible for small IDP without atypia, because of the minimal changes in tumor size and low incidence of malignancy after excision. However, to avoid a missed diagnosis of malignancy, excision should be considered if the lesion increases in size during follow-up.

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“…Second, 277 benign papillary lesions (218 from the US-guided DVAR group and 59 from the US follow-up without intervention group) underwent imaging follow-up rather than surgical excision. As previously reported, complete removal of all imaging evidence of a breast lesion by using the available percutaneous biopsy methods does not ensure complete excision, even if there is no evidence of a upgrade (8,10,25). The American Society of Breast Surgeons guidelines recommend that the decision to excise should be individualized according to risk, such as size of lesion, symptoms, and risk of breast cancer (26).…”

Section: Discussionmentioning

confidence: 99%

Benign Breast Papilloma without Atypia: Outcomes of Surgical Excision versus US-guided Directional Vacuum-assisted Removal or US Follow-up

Choi¹,

Kim²,

Jang³

et al. 2019

Radiology

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anagement of papillary lesions diagnosed as benign with core needle biopsy (CNB) is controversial because of the wide range of reported upgrade rates to ductal carcinoma in situ (DCIS) or invasive carcinoma at subsequent surgical excision (0%233%) (1-20). Image-guided percutaneous CNB is a highly reliable method for the diagnosis of breast lesions. However, in three studies (1,15,19), 9.4%-33.3% of papillary lesions confirmed to be benign papilloma without atypia with CNB were upgraded to DCIS or invasive cancer when reassessed after excision. Therefore, the investigators recommended surgical excision even for benign papilloma without atypia at CNB. However, those studies used stereotactic or US-guided CNB with 14-gauge or smaller needles.Several studies have suggested that US-guided directional vacuum-assisted removal (DVAR) is a satisfactory alternative to surgery for benign papilloma, whether for diagnostic or therapeutic purposes, with a 0% rate of upgrade to malignancy (2,3,7,11). However, the numbers of lesions examined have generally been small, with fewer than 50 such cases presented thus far (2,3,7,11). More recently, studies that included more than 50 patients with benign breast papilloma without atypia diagnosed with CNB have been published; however, either there was no follow-up in patients who did not undergo surgery (20) or the study population included patients who underwent stereotactic or MRI-guided vacuum-assisted biopsy (5,6,16). Longer follow-up results are needed to demonstrate that benign

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Management of intraductal papilloma without atypia of the breast diagnosed on core biopsy: Size and sampling matter

Cited by 10 publications

References 18 publications

Rates of upgrade to malignancy in surgical excision of intraductal papillomas of the breast: A retrospective cohort study

Rates of upgrade to malignancy in surgical excision of intraductal papillomas of the breast: A retrospective cohort study

Excision Can Be Delayed until Size Grows in Small Papillary Lesions of the Breast

Benign Breast Papilloma without Atypia: Outcomes of Surgical Excision versus US-guided Directional Vacuum-assisted Removal or US Follow-up

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