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Benign breast papillary lesions diagnosed on core biopsy: upgrade rate and risk factors associated with malignancy on surgical excision

Virchows Archiv volume 475, pages 701–707 (2019)Cite this article

Abstract

Evaluation of radiologically detected breast lesions is a common task in surgical pathology. Some benign lesions on biopsy are associated with an upgrade to in situ or invasive carcinoma on excision. The non-atypical breast papilloma has published upgrade rates of 0 to 29%. Traditionally, papillomas have been managed surgically, but the wide range of upgrade rates has raised uncertainty about the need for routine surgical excision. This study aims to identify risk factors associated with upgrade and determine the upgrade rate of non-atypical papillomas at our institution. In a retrospective review of pathology reports, we identified 266 patients with a diagnosis of benign papilloma on breast core biopsy. One hundred eighty-two patients underwent surgical resection. The final surgical pathology reports of all patients were reviewed and divided into one of two groups—benign or malignant. Twenty-one patients had a final diagnosis of in situ or invasive carcinoma, resulting in an upgrade rate of 12%. Radiologically detected lesions with calcifications were at higher risk for upgrade (OR = 4.45, 95% CI 1.08–18.27) than lesions without calcifications. Additionally, advanced patient age (OR = 1.07, 95% CI 1.03–1.13) and lesion size greater than 0.5 cm (OR = 2.59, 95% CI 0.38–17.48) was associated with upgrade to malignancy. Routine surgical excision of all papillomas is not recommended. Younger patients without high-risk features may benefit from clinical and radiologic follow-up alone. Accurate risk stratification will spare low-risk women unnecessary surgery.

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Abbreviations

BIRADS:

breast imaging-reporting and data system

SMMHC:

smooth muscle myosin heavy chain

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Author information

Affiliations

  1. Department of Pathology and Molecular Medicine, McMaster University Medical Center, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada

    Christine MacColl

  2. Department of Pathology and Molecular Medicine, Juravinski Hospital – Hamilton Health Sciences, 711 Concession St, Hamilton, ON, L8V 1C3, Canada

    Christine MacColl, Amir Salehi & Phillip Williams

  3. Department of Oncology, McMaster University, 711 Concession St, Hamilton, ON, L8V 1C3, Canada

    Sameer Parpia

  4. Department of Surgery, Juravinski Hospital – Hamilton Health Sciences, 711 Concession St, Hamilton, ON, L8V 1C3, Canada

    Nicole Hodgson

  5. Department of Radiology, Juravinski Hospital – Hamilton Health Sciences, 711 Concession St, Hamilton, ON, L8V 1C3, Canada

    Milita Ramonas

Authors
  1. Christine MacColl
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  2. Amir Salehi
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  3. Sameer Parpia
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  4. Nicole Hodgson
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  5. Milita Ramonas
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  6. Phillip Williams
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Contributions

The authors contributed to this study as follows: C. MacColl and P. Williams: study design and execution, identification of cases, review of histological slides, and manuscript preparation. A. Salehi: review of select histologic slides, support of study, and breast pathology consultant. S. Parpia: study design and statistical analysis. N. Hodgson: support of study and surgical consultant. M. Ramonas: support of study and radiological consultant. Participating investigator, Cathy Chang, retrieved and filed all histopathological slides for review.

Corresponding author

Correspondence to Christine MacColl.

Ethics declarations

The project was approved by the Hamilton Integrated Research Ethics Board (project number 2227-C).

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The authors declare that they have no conflicts of interest.

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MacColl, C., Salehi, A., Parpia, S. et al. Benign breast papillary lesions diagnosed on core biopsy: upgrade rate and risk factors associated with malignancy on surgical excision. Virchows Arch 475, 701–707 (2019). https://doi.org/10.1007/s00428-019-02626-5

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  • DOI: https://doi.org/10.1007/s00428-019-02626-5

Keywords

  • Breast neoplasms
  • Core biopsy
  • Intraductal papilloma
  • Upgrade