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Breast Cancer Research and Treatment

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01-11-2019 | Breast Cancer | Clinical trial

Risk of malignancy in papillary neoplasms of the breast

Authors: Claire Liu, Ravi Sidhu, Avi Ostry, Rebecca Warburton, Jin-Si Pao, Carol Dingee, Urve Kuusk, Elaine McKevitt

Published in: Breast Cancer Research and Treatment | Issue 1/2019

Abstract

Purpose

In recent years, routine excision of papillary neoplasms (PN) of the breast has been questioned and controversy exists over when excision is necessary. The aim of this study was to evaluate the upstage rate to malignancy of core needle biopsy (CNB) diagnosed PNs from multiple diagnostic centers in our area and to identify factors predictive of malignancy.

Methods

Patients presenting to our surgical center between 2013 and 2017 for excision of CNB PN were evaluated. The primary endpoint was upstage to malignancy. The association of age, diagnostic center where CNB performed, type of CNB, palpability, discharge, clinical exam size, imaging size, family history of breast cancer, and presence of atypia, as risk factors for upstaging to cancer were also evaluated.

Results

Of the 317 PN cases, 83 upstaged to malignancy following surgical excision. 77% of patients with CNB of Atypical PN upstaged, 39% of PN with concurrent atypical ductal hyperplasia, and 0% of PN with concurrent atypical lobular hyperplasia/flat epithelial atypia. Of the 206 non-atypical PNs on CNB, 3.4% upstaged to malignancy, but further review demonstrated a 1% upstage rate when atypia excluded. Factors found to be associated with malignancy included: older patient age, larger size, and presence of atypia.

Conclusion

We recommend excision of PN with atypia, concurrent cancerous lesion, or radiologic–pathologic non-concordance, and serial imaging follow up may be considered for image detected PN, less than 1 cm, with no atypia.

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Title: Risk of malignancy in papillary neoplasms of the breast
Authors: Claire Liu
Ravi Sidhu
Avi Ostry
Rebecca Warburton
Jin-Si Pao
Carol Dingee
Urve Kuusk
Elaine McKevitt
Publication date: 01-11-2019
Publisher: Springer US
Keywords: Breast Cancer
Breast Cancer
Published in: Breast Cancer Research and Treatment / Issue 1/2019
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-019-05367-w

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