Skip to main content

Intraductal Papilloma with Benign Pathology on Breast Core Biopsy: To Excise or Not?

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.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Ueng SH, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast: a review. Arch Pathol Lab Med. 2009;133:893–907.

    PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. Liberman L, Bracero N, Vuolo MA, et al. Percutaneous large-core biopsy of papillary breast lesions. AJR Am J Roentgenol. 1999;172:331–7.

    CAS  Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Sohn V, Keylock J, Arthurs Z, et al. Breast papillomas in the era of percutaneous needle biopsy. Ann Surg Oncol. 2007;14:2979–84.

    Article  PubMed  Google Scholar 

  12. 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.

    CAS  Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    CAS  Article  PubMed  Google Scholar 

  21. Jardines L. Management of nipple discharge. Am Surg. 1996;62:119–22.

    CAS  PubMed  Google Scholar 

  22. Sakorafas GH. Nipple discharge: current diagnostic and therapeutic approaches. Cancer Treat Rev. 2001;27:275–82.

    CAS  Article  PubMed  Google Scholar 

  23. 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.

  24. 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.

    Article  PubMed  Google Scholar 

  25. 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.

    CAS  Article  PubMed  Google Scholar 

  26. 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.

    CAS  Article  PubMed  Google Scholar 

  27. Vogel VG. The NSABP Study of Tamoxifen and Raloxifene (STAR) trial. Expert Rev Anticancer Ther. 2009;9:51–60.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Talar Tatarian MD.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5182-7

Keywords

  • Surgical Excision
  • Papilloma
  • Core Biopsy
  • Core Needle Biopsy
  • Atypical Ductal Hyperplasia