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.
Similar content being viewed by others
References
Li X, Weaver O, Desouki MM, Dabbs D, Shyum S, Carter G, Zhao C (2012) Microcalcification is an important factor in the management of breast intraductal papilloma diagnosed on core biopsy. Am J Clin Pathol 138(6):789–795
Kim MJ, Kim SI, Youk JH, Moon HJ, Kwak JY, Park BW, Kim EK (2011) The diagnosis of non-malignant papillary lesions of the breast: comparison of ultrasound-guided automated gun biopsy and vacuum assisted removal. Clin Radiol 66(6):530–535
El-Sayed ME, Rakha EA, Reed J, Lee AHS, Evans AJ, Ellis IO (2008) Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Histopathology 53(6):650–657
Chang JM, Moon WK, Cho N, Han W, Noh DY, Park IA, Jung EJ (2010) Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study. Eur Radiol 20(5):1093–1100
Chang JM, Moon WK, Cho N, Han W, Noh DY, Park IA, Jung EJ (2011) Management of ultrasonographically detected benign papillomas of the breast at core needle biopsy. AJR Am J Roentgenol 196(3):723–729
Pareja F, Corben A, Brennan SB et al (2016) Breast intraductal papilloma without atypia in radiologic-pathologic concordant core-needle biopsies: rate of upgrade to carcinoma at excision. Cancer 122(18):2819–2827
Cheng TY, Chen CM, Lee MY, Lin KJ, Hung CF, Yang PS, Yu BL, Yang CE, Tsai TJ, Lin CW (2009) Risk factor associated with conversion from nonmalignant to malignant diagnosis after surgical excision of breast papillary lesions. Ann Surg Oncol 16(12):3375–3379
Cyr AE, Novack D, Trinkaus K, Margenthaler JA, Gillanders WE, Eberlein TJ, Ritter J, Aft RL (2011) Are we overtreating papillomas diagnosed on core needle biopsy? Ann Surg Oncol 18(4):946–951
Jaffer S, Nagi C, Beliweiss IJ (2009) Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy. Cancer 115(13):2827–2843
Jung SY, Kang HS, Kwon Y, Min SY, Kim EA, Ko KL, Lee S, Kim SW (2010) Risk factors for malignancy in benign papillomas of the breast on core needle biopsy. World J Surg 34(2):261–265
Rizzo M, Lund MJ, Oprea G, Schniederjan M, Wood WC, Mosunjac M (2008) Surgical follow-up and clinical presentation of 142 breast papillary lesions diagnosed by ultrasound –guided core-needle biopsy. Ann Surg Oncol 15(4):1040–1047
Shin HJ, Kim HH, Kim SM, Yang HR, Sohn JH, Kwon GY, Gong G (2008) Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy: comparison of sonographic features and biopsy methods. AJR Am J Roentgenol 190(3):630–636
Kil WH, Cho EY, Kim JH, Nam SJ, Yang JH (2007) Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy? Breast 17(3):258–262
Skandarajah AR, Field L, Yuen Larn Mou A et al (2008) Benign papilloma on core biopsy requires surgical excision. Ann Surg Oncol 15(8):2272–2277
Rozentsvavg E, Carver K, Borkar S et al (2011) Surgical excision of benign papillomas diagnosed with core biopsy: a hospital community approach. Radiol Res Pract 2011:1–4. https://doi.org/10.1155/2011/679864
Youk JH, Kim EK, Kwak JY, Son EJ, Park BW, Kim SI (2011) Benign papilloma without atypia diagnosed at US-guided 14-guage core-needle biopsy: clinical and US features predictive of upgrade to malignancy. Radiology 258(1):81–88
Fu CY, Chen TW, Hong ZJ, Chan DC, Young CY, Chen CJ, Hsieh CB, Hsu HH, Peng YJ, Lu HE, Yu JC (2012) Papillary breast lesions diagnosed by core biopsy require complete excision. Eur J Surg Oncol 38(11):1029–1035
Holley SO, Appleton CM, Farria DM et al (2012) Pathologic outcomes of nonmalignant papillary breast lesions diagnosed at imaging-guided core needle biopsy. Radiology 256(2):379–384
Jatake K, DeBrot M, Goldberg F, Muradali D, O’Malley FP, Mulligan AM (2012) Papillary lesions of the breast: impact of breast pathology subspecialization on core biopsy and excision diagnosis. Am J Surg Pathol 36(4):544–551
Rizzo M, Linebarger J, Lowe MC, Pan L, Gabram SGA, Vasquez L, Cohen MA, Mosunjac M (2012) Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow up. J Am Coll Surg 214(3):280–287
Shouhed D, Amersi FF, Spurrier R, Dang C, Astvatsaturyan K, Bose S, Phillips E (2012) Intraductal papillary lesions of the breast: clinical and pathological correlation. Am Surg 78(10):1161–1165
Jaffer S, Bleiweiss IJ, Nagi (2013) Incidental intraductal papillomas (<2 mm) of the breast diagnosed on needle core biopsy do not need to be excised. Breast J 19(2):130–133
Swapp RE, Glazebrook KN, Jones KN, Brandts HM, Reynolds C, Visscher DW, Hieken TJ (2013) Management of benign intraductal solitary papilloma diagnosed on core needle biopsy. Ann Surg Oncol 20(6):1900–1905
Wiratkapun C, Keeratitragoon T, Lertsithichai P, Chanplakorn (2013) Upgrading rate of papillary breast lesions diagnosed on core-needle biopsy. Diagn Interv Radiol 19(5):371–376
Glenn ME, Throckmorton AD, Thomison JB 3rd, Bienkowski RS (2015) Papillomas of the breast 15 mm or smaller: 4-year experience in a community based dedicated breast imaging clinic. Ann Surg Oncol 22(4):1133–1139
Tartarian T, Sokas C, Rufail M et al (2016) Intraductal papilloma with benign pathology on breast core biopsy: to excise or not? Ann Surg Oncol 23(8):2501–2507
Wen X, Cheng W (2013) Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol 20(1):94–101
Lewis JT, Hartmann LC, Vierkant RA et al (2006) An analysis of breast cancer risk in women with single, multiple and atypical papilloma. Am J Surg Pathol 30:665–672
Weisman PS, Sutton BJ, Siziopikou KP, Hansen N, Khan SA, Neuschler EI, Rohan SM, Franz JM, Sullivan ME (2014) Non-mass-associated intraductal papillomas: is excision necessary? Human Pathol 45:583–588
Rageth CJ, O’Flynn EAM, Comstock C, Kurtz C, Kubik R, Madjar H, Lepori D, Kampmann G, Mundinger A, Baege A, Decker T, Hosch S, Tausch C, Delaloye JF, Morris E, Varga Z (2016) First international consensus conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat 159:203–213
Wyss P, Varga Z, Rossle M, Rageth CJ (2014) Papillary lesions of the breast: outcomes of 156 patients managed without excisional biopsy. Breast J 20:394–401
Youk JH, Kim MJ, Son EJ, Kwak JY, Kim EK (2012) US-guided vacuum-assisted percutaneous excision for management of benign papilloma without atypia diagnosed at US-guided 14-guage core needle biopsy. Ann Surg Oncol 19:922–928
Author information
Authors and Affiliations
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
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.
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00428-018-2449-3