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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2009

01-12-2009 | Breast Oncology

Risk Factors Associated with Conversion from Nonmalignant to Malignant Diagnosis After Surgical Excision of Breast Papillary Lesions

Authors: Tsung-Yen Cheng, MD, Chii-Ming Chen, MD, Ming-Yuan Lee, MD, Kwang-Jane Lin, MD, Cheng-Fung Hung, MS, Po-Sheng Yang, MD, Ben-Long Yu, MD, Chen-En Yang, MD, Tzu-Jung Tsai, MD, Chung-Wei Lin, MD

Published in: Annals of Surgical Oncology | Issue 12/2009

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Abstract

Purpose

Management of papillary lesions of the breast identified during preoperative tissue diagnosis remains controversial. This study was designed to analyze the clinical factors associated with under-diagnosis of malignancy in breast papillary lesions.

Methods

Patients with a preoperative tissue diagnosis of benign or atypical papillary lesions, who received surgical excision between 1991 and 2005, were identified. Age of diagnosis, family history of breast cancer, presentation of nipple discharge, palpable mass, mammogram grading, size of lesion, and final pathological diagnosis were analyzed. Tissue sections were reviewed to confirm the diagnosis of malignancy and reasons of discrepancy.

Results

A total of 205 women with 228 papillary lesions were studied. The median age was 42 (range, 12–83) years. Malignancies were diagnosed after surgery in 21 cases (9.2%). Patients aged 45 years or older and atypical lesions according to fine needle aspiration cytology (FNAC) or core needle biopsy (CNB) were associated with higher risk for postoperative malignant diagnosis with P values of 0.0008 and <0.0001, respectively. Pathology review of 19 lesions with malignancy revealed that reasons for preoperative nonmalignant diagnosis were borderline lesions in nine (47.3%), sampling problem in six (31.5%), interpretation error in three (15.7%) and uninterpretable sample in one (5.2%).

Conclusions

In this cohort, 9.21% of preoperative nonmalignant papillary lesions were converted to malignant diagnosis after surgery. Atypical lesions and patients aged 45 years or older were significant factors associated with such conversion. Surgical excision should be considered for papillary lesions of breast, especially for patients with the identified risk factors.
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Metadata
Title
Risk Factors Associated with Conversion from Nonmalignant to Malignant Diagnosis After Surgical Excision of Breast Papillary Lesions
Authors
Tsung-Yen Cheng, MD
Chii-Ming Chen, MD
Ming-Yuan Lee, MD
Kwang-Jane Lin, MD
Cheng-Fung Hung, MS
Po-Sheng Yang, MD
Ben-Long Yu, MD
Chen-En Yang, MD
Tzu-Jung Tsai, MD
Chung-Wei Lin, MD
Publication date
01-12-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0637-8

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