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

Annals of Surgical Oncology volume 23, pages 2501–2507 (2016)Cite this article

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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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Talar Tatarian MD, Claire Sokas BS, Melissa Lazar MD, Sanchi Malhotra BS, Theodore Tsangaris MD, FACS & Adam C. Berger MD, FACS

  2. Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Miguel Rufail MD, PhD & Juan P. Palazzo MD

  3. Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Elizabeth Hsu MD

Authors
  1. Talar Tatarian MD
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  2. Claire Sokas BS
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  3. Miguel Rufail MD, PhD
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  4. Melissa Lazar MD
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  5. Sanchi Malhotra BS
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  6. Juan P. Palazzo MD
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  7. Elizabeth Hsu MD
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  8. Theodore Tsangaris MD, FACS
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  9. Adam C. Berger MD, FACS
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Correspondence to Talar Tatarian MD.

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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

Keywords

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