Nipple Discharge: When is it Worrisome?

Gulati, Malvika; Singla, Veenu; Singh, Tulika; Bal, Amanjit; Irrinki, R N Naga Santhosh

doi:10.1067/j.cpradiol.2023.06.017

Cited by 1 publication

(1 citation statement)

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“…IPA is a lesion characterized histopathologically by a pedunculated intraductal mass on a fibrovascular stalk, and represents the most common benign cause of bloody nipple discharge [ 6 , 7 ]. Historically, the risk of upgrade to in situ or invasive carcinoma following the diagnosis of a papillary lesion on core needle biopsy (CNB) was as high as 67% [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Distance of Biopsy-Confirmed High-Risk Breast Lesion from Concurrently Identified Breast Malignancy Associated with Risk of Carcinoma at the High-Risk Lesion Site

Le,

O’Keefe,

Khan

et al. 2024

Cancers

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High-risk breast lesions including incidental intraductal papilloma without atypia (IPA), lobular hyperplasia (LCIS or ALH), flat epithelial atypia (FEA) and complex sclerosing lesion (CSL) are not routinely excised due to low upgrade rates to carcinoma. We aim to identify features of these lesions predictive of upgrade when identified concurrently with invasive disease. Methods: A single-center retrospective cohort study was performed for patients who underwent multi-site lumpectomies with invasive disease at one site and a high-risk lesion at another site between 2006 and 2021. A multinomial logistic regression was performed. Results: Sixty-five patients met the inclusion criteria. Four patients (6.2%) had an upgrade to in situ disease (DCIS) and one (1.5%) to invasive carcinoma. Three upgraded high-risk lesions were ipsilateral to the concurrent carcinoma and two were contralateral. In the multivariate model, a high-risk lesion within 5 cm of an ipsilateral malignancy was associated with increased risk of upgrade. The 3.8% upgrade rate for high-risk lesions located greater than 5 cm from ipsilateral malignancy or in the contralateral breast suggests that omission of excisional biopsy may be considered. Excisional biopsy of lesions within 5 cm of ipsilateral malignancy is recommended given the 25% upgrade risk in our series.

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