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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2008

01-04-2008 | Breast Oncology

Surgical Follow-Up and Clinical Presentation of 142 Breast Papillary Lesions Diagnosed by Ultrasound-Guided Core-Needle Biopsy

Authors: Monica Rizzo, MD, Mary Jo Lund, PhD, Gabriela Oprea, MD, Matthew Schniederjan, MD, William C Wood, MD, Marina Mosunjac, MD

Published in: Annals of Surgical Oncology | Issue 4/2008

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Abstract

Background

The clinical management of breast intraductal papilloma (IDP) remains controversial. The objective of this study was to survey a large cohort of benign IDP diagnosed on core needle biopsy (CNB) and to evaluate their clinical presentation and potential risk of associated atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), ductal carcinoma in situ (DCIS) or invasive carcinoma as identified by follow-up surgical excision.

Methods

We analyzed 345 IDP on CNB; 142 (41.2%) received a subsequent surgical excision while 203 (58.8%) cases did not. Specimens were categorized as IDP, IPD+ADH, IDP+ALH, and DCIS. In patients with surgical follow-up the upgrade to a lesion of greater clinical significance was analyzed according to race, clinical presentation and multiplicity of papillomas.

Results

Of the 142 cases, 125 (93.9%) patients had a single IDP, while 17 cases were among 8 patients with multiple IDPs. Patients were predominantly asymptomatic with CNB obtained as follow-up to an abnormal mammogram. Among solitary benign IDP, nearly 25% were upgraded (p < 0.001): 14.0% to ADH and 10.5% to DCIS. For patients with IDP+ADH on initial CNB, 22.2% were upgraded to DCIS. Of the asymptomatic cases 11.4% were upgraded to DCIS, while none of the symptomatic patients showed such upgrade (p < 0.001). In patients with no surgical excision 17 (8.3%) continue to have an abnormal mammogram.

Conclusions

We recommend routine mammogram and surgical excision of all IDPs identified on CNB because almost one-fourth (24.5%) of solitary IDP at CNB were upgraded to either ADH or DCIS and the majority of cases were asymptomatic.
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Metadata
Title
Surgical Follow-Up and Clinical Presentation of 142 Breast Papillary Lesions Diagnosed by Ultrasound-Guided Core-Needle Biopsy
Authors
Monica Rizzo, MD
Mary Jo Lund, PhD
Gabriela Oprea, MD
Matthew Schniederjan, MD
William C Wood, MD
Marina Mosunjac, MD
Publication date
01-04-2008
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-007-9780-2

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