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Surgical Follow-Up and Clinical Presentation of 142 Breast Papillary Lesions Diagnosed by Ultrasound-Guided Core-Needle Biopsy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The clinical management of breast intraductal papilloma (IDP) remains controversial. The objective of this study was to survey a large cohort of benign IDP diagnosed on core needle biopsy (CNB) and to evaluate their clinical presentation and potential risk of associated atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), ductal carcinoma in situ (DCIS) or invasive carcinoma as identified by follow-up surgical excision.

Methods

We analyzed 345 IDP on CNB; 142 (41.2%) received a subsequent surgical excision while 203 (58.8%) cases did not. Specimens were categorized as IDP, IPD+ADH, IDP+ALH, and DCIS. In patients with surgical follow-up the upgrade to a lesion of greater clinical significance was analyzed according to race, clinical presentation and multiplicity of papillomas.

Results

Of the 142 cases, 125 (93.9%) patients had a single IDP, while 17 cases were among 8 patients with multiple IDPs. Patients were predominantly asymptomatic with CNB obtained as follow-up to an abnormal mammogram. Among solitary benign IDP, nearly 25% were upgraded (p < 0.001): 14.0% to ADH and 10.5% to DCIS. For patients with IDP+ADH on initial CNB, 22.2% were upgraded to DCIS. Of the asymptomatic cases 11.4% were upgraded to DCIS, while none of the symptomatic patients showed such upgrade (p < 0.001). In patients with no surgical excision 17 (8.3%) continue to have an abnormal mammogram.

Conclusions

We recommend routine mammogram and surgical excision of all IDPs identified on CNB because almost one-fourth (24.5%) of solitary IDP at CNB were upgraded to either ADH or DCIS and the majority of cases were asymptomatic.

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Acknowledgments

This manuscript was supported in part by awards from the Avon Foundation (MR, MJL). This work was presented in part at the Miami Breast Conference, February 2007, Miami and in part at the United States and Canadian Academy of Pathology Annual Meeting, March 2007 San Diego.

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Authors and Affiliations

  1. Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, United States

    Monica Rizzo MD, Mary Jo Lund PhD & William C Wood MD

  2. Georgia Cancer Center for Excellence at Grady, Emory University, Atlanta, Georgia, United States

    Monica Rizzo MD & Mary Jo Lund PhD

  3. Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, United States

    Mary Jo Lund PhD

  4. Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States

    Gabriela Oprea MD, Matthew Schniederjan MD & Marina Mosunjac MD

  5. 550 Peachtree Street, Atlanta, GA, 30308, United States

    Monica Rizzo MD

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  1. Monica Rizzo MD
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  2. Mary Jo Lund PhD
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  3. Gabriela Oprea MD
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  4. Matthew Schniederjan MD
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  5. William C Wood MD
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  6. Marina Mosunjac MD
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Correspondence to Monica Rizzo MD.

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Rizzo, M., Lund, M.J., Oprea, G. et al. Surgical Follow-Up and Clinical Presentation of 142 Breast Papillary Lesions Diagnosed by Ultrasound-Guided Core-Needle Biopsy. Ann Surg Oncol 15, 1040–1047 (2008). https://doi.org/10.1245/s10434-007-9780-2

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  • DOI: https://doi.org/10.1245/s10434-007-9780-2

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