ASO Author Reflections: Management of Benign Breast Intraductal Papillomas Without Atypia Diagnosed at Imaging-Guided Biopsies

Excerpt

Papillary lesions of the breast are epithelial proliferations ranging from benign intraductal papillomas (IDPs), papillomas with atypia, and papillary carcinomas (intraductal and invasive). Imaging-guided core needle biopsy (CNB) plays a vital role in the diagnosis of papillary lesions of the breast. Underdiagnosis is a concern when CNB reveals a papilloma with or without atypia. Since the literature reports a 22–63% upgrade rate to malignancy for papillomas with atypia, the standard care for atypical papillomas detected on CNB is surgical excision. Management of benign IDPs without atypia found on CNB is controversial given the wide range of upgrade rates to malignancy reported in the literature (from 0 to 33%).1^,2 Some propose that all benign papillomas found on CNB should be surgically removed, while others advocate that imaging surveillance may be a safe practice in selected patients. …