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Outcomes of benign intraductal papillomas diagnosed on core biopsy: a review of 104 cases with subsequent excision from a single institution

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Abstract

A diagnosis of papilloma with atypia on core biopsy (CB) requires excision, as the risk of associated malignancy is high (average 36.9%). The management of benign intraductal papillomas (IP) diagnosed on CB is controversial due to varying upgradation rates (0–29%, average 7%) reported on excision. Our aim was to study the clinical, radiological, and pathological features associated with benign IP upgradation at our institution. An electronic data base search (keyword papilloma), from Jan. 2000–Aug. 2015 identified 258 CBs. After exclusions, 104 CBs of benign IPs with subsequent excisions from 101 females were reviewed. The clinical, radiological, and pathological features between IPs that had upgrades (defined as malignancy or atypical ductal hyperplasia) and non-upgraded IPs were compared using descriptive statistics. Studies of benign IP on CB with at least 50 follow-up excisions published between 2008 and 2016 were analyzed. Residual IP was present in 83.6% (87/104) of reviewed excisions. There were six upgrades (5.6%) (4 to malignancy (3.8%) and 2 to atypical ductal hyperplasia).Upgrades were associated with mass on imaging with a trend to significance (p = .05). Two cases with malignant upgrade had a history of contralateral cancer. An analysis of 25 published studies showed an average malignant upgrade of 5.7% (182/3164). The majority of benign IP are not upgraded on excision; thus, not all need to be excised. Those that may warrant excision are those with prior history of carcinoma, those with a mass on imaging, and/or suboptimal or imaging-discordant CB sampling.

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Authors and Affiliations

Authors

Contributions

JRA contributed to the study design, collected and interpreted the data, performed slide review, and wrote the manuscript. JMJ contributed to study design, performed slide review, contributed to data analysis and interpretation, and critically edited the manuscript. LZ performed statistical analysis of the data and contributed to the manuscript. DOJ contributed to data interpretation and critically edited the manuscript. AJW conceived the study, contributed to the study design, performed slide review, interpreted the data, and critically edited the manuscript.

Corresponding author

Correspondence to Jaya Ruth Asirvatham.

Ethics declarations

This is a retrospective study involving human FFPE tissues, approved by the University of Michigan Institutional Review Board. A waiver for informed consent was obtained.

Conflict of interest

This paper was presented in part at the annual meeting of the United States and Canadian Academy of Pathologists in Seattle, WA, on March 17, 2016. Dr. Asirvatham is presently affiliated with the University of Florida. Dr. Jorns is presently affiliated with the Medical College of Wisconsin. The authors declare that they have no conflict of interest.

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Asirvatham, J.R., Jorns, J.M., Zhao, L. et al. Outcomes of benign intraductal papillomas diagnosed on core biopsy: a review of 104 cases with subsequent excision from a single institution. Virchows Arch 473, 679–686 (2018). https://doi.org/10.1007/s00428-018-2449-3

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  • DOI: https://doi.org/10.1007/s00428-018-2449-3

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