Risk of malignancy in papillary neoplasms of the breast
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In recent years, routine excision of papillary neoplasms (PN) of the breast has been questioned and controversy exists over when excision is necessary. The aim of this study was to evaluate the upstage rate to malignancy of core needle biopsy (CNB) diagnosed PNs from multiple diagnostic centers in our area and to identify factors predictive of malignancy.
Patients presenting to our surgical center between 2013 and 2017 for excision of CNB PN were evaluated. The primary endpoint was upstage to malignancy. The association of age, diagnostic center where CNB performed, type of CNB, palpability, discharge, clinical exam size, imaging size, family history of breast cancer, and presence of atypia, as risk factors for upstaging to cancer were also evaluated.
Of the 317 PN cases, 83 upstaged to malignancy following surgical excision. 77% of patients with CNB of Atypical PN upstaged, 39% of PN with concurrent atypical ductal hyperplasia, and 0% of PN with concurrent atypical lobular hyperplasia/flat epithelial atypia. Of the 206 non-atypical PNs on CNB, 3.4% upstaged to malignancy, but further review demonstrated a 1% upstage rate when atypia excluded. Factors found to be associated with malignancy included: older patient age, larger size, and presence of atypia.
We recommend excision of PN with atypia, concurrent cancerous lesion, or radiologic–pathologic non-concordance, and serial imaging follow up may be considered for image detected PN, less than 1 cm, with no atypia.
KeywordsPapillary neoplasms Core needle biopsy Breast cancer Surgery
Atypical ductal hyperplasia
Atypical lobular hyperplasia
Atypical papillary neoplasms
Core needle biopsy
Ductal carcinoma in situ
Flat epithelial atypia
Myoepithelial cell layer
The authors would like to acknowledge the input of the physicians in the Departments of Pathology, Surgery, and Radiology in our area that contributed to the development of our clinical pathways. We would also like to acknowledge Guilaine Boyce who helped with manuscript preparation and Kaidi Liu, Leo Chen, and Amy Wang who helped with data analysis.
Compliance with ethical standards
Conflict of interest
The authors of this manuscript have no conflicts of interest to declare for this publication.
This study was approved by the Research Ethics Board by the University of British Columbia and Providence Health Care. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained as appropriate from all participants in the study as per the Research Ethics Board Standards.
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