Skip to main content

Advertisement

Log in

Risk Factors for Malignancy in Benign Papillomas of the Breast on Core Needle Biopsy

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

This study was designed to evaluate the clinical and pathologic parameters of benign papillomas diagnosed on core needle biopsy (CNB) and predict malignancy risk after surgical excision.

Methods

We retrospectively reviewed clinicopathologic findings for 160 CNB-diagnosed benign papillomas followed by surgical excision from 154 patients.

Results

Ten (6.3%) of the excised lesions were diagnosed as malignant. Univariate analysis showed that those that were palpable on physical examination, detected as a mass on mammography, or >1 cm on sonography were significantly associated with malignancy. In multivariate analysis, lesions that were palpable (odds ratio (OR), 29.2; 95% confidence interval (CI), 4.06–209.58; P = 0.001) or detected as a mass (OR, 5.68; 95% CI 1.08–29.87; P = 0.04) remained significantly associated with malignancy. In a CART analysis, including all variables, lesions that were palpable and associated with a mass on mammogram were confirmed as malignant.

Conclusions

Breast lesions diagnosed as benign papillomas on CNB had a 6.3% risk of being malignant. The risk was highest for lesions that were palpable and detectable as a mass on a mammogram. In addition, the low-risk patients avoid immediate surgical excision, although they should be followed carefully.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Rosen PP (1986) Arthur Purdy Stout and papilloma of the breast. Comments on the occasion of his 100th birthday. Am J Surg Pathol 10:100–107

    PubMed  Google Scholar 

  2. Berg WA (2004) Image-guided breast biopsy and management of high-risk lesions. Radiol Clin North Am 42:935–946

    Article  PubMed  Google Scholar 

  3. Reynolds HE (2000) Core needle biopsy of challenging benign breast conditions: a comprehensive literature review. AJR Am J Roentgenol 174:1245–1250

    CAS  PubMed  Google Scholar 

  4. Ivan D, Selinko V, Sahin AA et al (2004) Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy. Mod Pathol 17:165–171

    Article  PubMed  Google Scholar 

  5. Liberman L, Bracero N, Vuolo MA et al (1999) Percutaneous large-core biopsy of papillary breast lesions. AJR Am J Roentgenol 172:331–337

    CAS  PubMed  Google Scholar 

  6. Mercado CL, Hamele-Bena D, Singer C et al (2001) Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy. Radiology 221:650–655

    Article  CAS  PubMed  Google Scholar 

  7. Ciatto S, Andreoli C, Cirillo A et al (1991) The risk of breast cancer subsequent to histologic diagnosis of benign intraductal papilloma follow-up study of 339 cases. Tumori 77:41–43

    CAS  PubMed  Google Scholar 

  8. Agoff SN, Lawton TJ (2004) 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 122:440–443

    Article  PubMed  Google Scholar 

  9. Ashkenazi I, Ferrer K, Sekosan M et al (2007) Papillary lesions of the breast discovered on percutaneous large core and vacuum-assisted biopsies: reliability of clinical and pathological parameters in identifying benign lesions. Am J Surg 194:183–188

    Article  PubMed  Google Scholar 

  10. Liberman L, Tornos C, Huzjan R et al (2006) Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR Am J Roentgenol 186:1328–1334

    Article  PubMed  Google Scholar 

  11. Mercado CL, Hamele-Bena D, Oken SM et al (2006) Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology 238:801–808

    Article  PubMed  Google Scholar 

  12. Rizzo M, Lund MJ, Oprea G et al (2008) Surgical follow-up and clinical presentation of 142 breast papillary lesions diagnosed by ultrasound-guided core-needle biopsy. Ann Surg Oncol 15:1040–1047

    Article  PubMed  Google Scholar 

  13. Cardenosa G, Eklund GW (1991) Benign papillary neoplasms of the breast: mammographic findings. Radiology 181:751–755

    CAS  PubMed  Google Scholar 

  14. Soo MS, Williford ME, Walsh R et al (1995) Papillary carcinoma of the breast: imaging findings. AJR Am J Roentgenol 164:321–326

    CAS  PubMed  Google Scholar 

  15. Haagensen CD, Stout AP, Phillips JS (1951) The papillary neoplasms of the breast. I. Benign intraductal papilloma. Ann Surg 133:18–36

    Article  CAS  PubMed  Google Scholar 

  16. Woods ER, Helvie MA, Ikeda DM et al (1992) Solitary breast papilloma: comparison of mammographic, galactographic, and pathologic findings. AJR Am J Roentgenol 159:487–491

    CAS  PubMed  Google Scholar 

  17. Sakr R, Rouzier R, Salem C et al (2008) Risk of breast cancer associated with papilloma. Eur J Surg Oncol 34:1304–1308

    CAS  PubMed  Google Scholar 

  18. Papotti M, Eusebi V, Gugliotta P et al (1983) Immunohistochemical analysis of benign and malignant papillary lesions of the breast. Am J Surg Pathol 7:451–461

    Article  CAS  PubMed  Google Scholar 

  19. Carter D (1977) Intraductal papillary tumors of the breast: a study of 78 cases. Cancer 39:1689–1692

    Article  CAS  PubMed  Google Scholar 

  20. Moore SW, Pearce J, Ring E (1961) Intraductal papilloma of the breast. Surg Gynecol Obstet 112:153–158

    CAS  PubMed  Google Scholar 

  21. Renshaw AA, Derhagopian RP, Tizol-Blanco DM et al (2004) Papillomas and atypical papillomas in breast core needle biopsy specimens: risk of carcinoma in subsequent excision. Am J Clin Pathol 122:217–221

    Article  PubMed  Google Scholar 

  22. Lewis JT, Hartmann LC, Vierkant RA et al (2006) An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol 30:665–672

    Article  PubMed  Google Scholar 

  23. Hoda SA, Rosen PP (2006) Observations on the pathologic diagnosis of selected unusual lesions in needle core biopsies of breast. Breast J 10:522–527

    Article  Google Scholar 

  24. Valdes EK, Tartter PI, Genelus-Dominique E et al (2006) Significance of papillary lesions at percutaneous breast biopsy. Ann Surg Oncol 13:480–482

    Article  PubMed  Google Scholar 

  25. Philpotts LE, Shaheen NA, Jain KS et al (2000) Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology 216:831–837

    CAS  PubMed  Google Scholar 

  26. Carder PJ, Garvican J, Haigh I et al (2005) Needle core biopsy can reliably distinguish between benign and malignant papillary lesions of the breast. Histopathology 46:320–327

    Article  CAS  PubMed  Google Scholar 

  27. Rosen EL, Bentley RC, Baker JA et al (2002) Imaging-guided core needle biopsy of papillary lesions of the breast. AJR Am J Roentgenol 179:1185–1192

    PubMed  Google Scholar 

  28. Ahmadiyeh N, Stoleru MA, Raza S et al (2009) Management of intraductal papillomas of the breast: an analysis of 129 cases and their outcome. Ann Surg Oncol 16:2264–2269

    Article  PubMed  Google Scholar 

  29. Sakr R, Rouzier R, Salem C et al (2008) Risk of breast cancer associated with papilloma. Eur J Surg Oncol 34:1304–1308

    CAS  PubMed  Google Scholar 

  30. Sydnor MK, Wilson JD, Hijaz TA et al (2007) Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy. Radiology 242:58–62

    Article  PubMed  Google Scholar 

  31. Plantade R, Gerard F, Hammou JC (2006) Management of non malignant papillary lesions diagnosed on percutaneous biopsy. J Radiol 87:299–305

    Article  CAS  PubMed  Google Scholar 

  32. Puglisi F, Zuiani C, Bazzocchi M et al (2003) Role of mammography, ultrasound and large core biopsy in the diagnostic evaluation of papillary breast lesions. Oncology 65:311–315

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Han-Sung Kang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jung, SY., Kang, HS., Kwon, Y. et al. Risk Factors for Malignancy in Benign Papillomas of the Breast on Core Needle Biopsy. World J Surg 34, 261–265 (2010). https://doi.org/10.1007/s00268-009-0313-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-0313-y

Keywords

Navigation