Abstract
Background
The management of intraductal papillomas on core biopsy continues to be controversial. Papillomas with atypia are typically excised. However, it is unclear whether surgical excision is warranted for benign lesions.
Methods
A retrospective review of our institution’s pathology and radiology databases from January 2009 through May 2014 identified 119 patients with a diagnosis of benign papilloma without atypia on core biopsy. We determined the rate of carcinoma identification on surgical excision.
Results
The average patient age was 52.8 years (range 24–84 years). Indication for core biopsy included: abnormal imaging (n = 106), nipple discharge (n = 21), or palpable mass (n = 24). Seventy-five patients underwent surgical excision after core biopsy. Sixteen patients (21.3 %) had atypia in the excision specimen (combination atypical ductal hyperplasia, n = 11; atypical lobular hyperplasia, n = 8; lobular carcinoma-in situ, n = 3), 15 (93.8 %) of which were in the surrounding breast tissue. Two patients (2.7 %) had malignancy (ductal carcinoma-in situ and micropapillary carcinoma-in situ). As a result of surgical findings, 12 % of patients had a change in management. In comparing those with benign findings on surgical pathology and those whose disease was upstaged, there was no statistically significant difference in family history of breast cancer, indication for core biopsy, mammographic findings, or location of papilloma.
Conclusions
Benign papillomas diagnosed on core biopsy are rarely upstaged to malignancy on surgical excision. However, at least 21 % of patients may have atypical findings in the surrounding tissue, which could change clinical management. Surgical excision should be considered in patients with benign papillomas.
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References
Ueng SH, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast: a review. Arch Pathol Lab Med. 2009;133:893–907.
Liberman L, Tornos C, Huzjan R, Bartella L, Morris EA, Dershaw DD. Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR Am J Roentgenol. 2006;186:1328–34.
Harjit K, Willsher PC, Bennett M, Jackson LR, Metcalf C, Saunders CM. Multiple papillomas of the breast: is current management adequate? Breast. 2006;15:777–81.
Liberman L, Bracero N, Vuolo MA, et al. Percutaneous large-core biopsy of papillary breast lesions. AJR Am J Roentgenol. 1999;172:331–7.
Rosen EL, Bentley RC, Baker JA, Soo MS. Imaging-guided core needle biopsy of papillary lesions of the breast. AJR Am J Roentgenol. 2002;179:1185–92.
Ivan D, Selinko V, Sahin AA, Sneige N, Middleton LP. Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy. Mod Pathol. 2004;17:165–71.
Jacobs TW, Connolly JL, Schnitt SJ. Nonmalignant lesions in breast core needle biopsies: to excise or not to excise?. Am J Surg Pathol. 2002;26:1095–110.
Ahmadiyeh N, Stoleru MA, Raza S, Lester SC, Golshan M. Management of intraductal papillomas of the breast: an analysis of 129 cases and their outcome. Ann Surg Oncol. 2009;16:2264–9.
Agoff SN, Lawton TJ. Papillary lesions of the breast with and without atypical ductal hyperplasia: can we accurately predict benign behavior from core needle biopsy? Am J Clin Pathol. 2004;122:440–3.
Renshaw AA, Derhagopian RP, Tizol-Blanco DM, Gould EW. Papillomas and atypical papillomas in breast core needle biopsy specimens: risk of carcinoma in subsequent excision. Am J Clin Pathol. 2004;122:217–21.
Sohn V, Keylock J, Arthurs Z, et al. Breast papillomas in the era of percutaneous needle biopsy. Ann Surg Oncol. 2007;14:2979–84.
Page DL, Salhany KE, Jensen RA, Dupont WD. Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer. 1996;78:258–66.
Rizzo M, Lund MJ, Oprea G, Schniederjan M, Wood WC, Mosunjac M. Surgical follow-up and clinical presentation of 142 breast papillary lesions diagnosed by ultrasound-guided core-needle biopsy. Ann Surg Oncol. 2008;15:1040–7.
Jaffer S, Nagi C, Bleiweiss IJ. Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy. Cancer. 2009;115:2837–43.
Bernik SF, Troob S, Ying BL, et al. Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up. Am J Surg. 2009;197:473–8.
Holley SO, Appleton CM, Farria DM, et al. Pathologic outcomes of nonmalignant papillary breast lesions diagnosed at imaging-guided core needle biopsy. Radiology. 2012;265:379–84.
Wen X, Cheng W. Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol. 2013;20:94–101.
Nakhlis F, Ahmadiyeh N, Lester S, Raza S, Lotfi P, Golshan M. Papilloma on core biopsy: excision vs observation. Ann Surg Oncol. 2015;22:1479–82.
Swapp RE, Glazebrook KN, Jones KN, et al. Management of benign intraductal solitary papilloma diagnosed on core needle biopsy. Ann Surg Oncol. 2013;20:1900–5.
Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005;353:229–37.
Jardines L. Management of nipple discharge. Am Surg. 1996;62:119–22.
Sakorafas GH. Nipple discharge: current diagnostic and therapeutic approaches. Cancer Treat Rev. 2001;27:275–82.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: breast cancer screening and diagnosis. 2015. http://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf.
Hawley JR, Lawther H, Erdal BS, Yildiz VO, Carkaci S. Outcomes of benign breast papillomas diagnosed at image-guided vacuum-assisted core needle biopsy. Clin Imaging. 2015;39:576–81.
Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst. 1998;90:1371–88.
Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst. 2005;97:1652–62.
Vogel VG. The NSABP Study of Tamoxifen and Raloxifene (STAR) trial. Expert Rev Anticancer Ther. 2009;9:51–60.
Vogel VG, Costantino JP, Wickerham DL, et al. Update of the national surgical adjuvant breast and bowel project study of Tamoxifen and Raloxifene (STAR) P-2 trial: preventing breast cancer. Cancer Prev Res (Phila). 2010;3:696–706.
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Tatarian, T., Sokas, C., Rufail, M. et al. Intraductal Papilloma with Benign Pathology on Breast Core Biopsy: To Excise or Not?. Ann Surg Oncol 23, 2501–2507 (2016). https://doi.org/10.1245/s10434-016-5182-7
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DOI: https://doi.org/10.1245/s10434-016-5182-7