Risk of breast cancer associated with papilloma

The purpose of this study was to investigate the risk of carcinoma in patients with a diagnosis of papilloma of the breast made on ultrasound large core biopsy or stereotactic vacuum-assisted biopsies.

This retrospective database review (2000-2007) included 130 patients with a papilloma diagnosed on preoperative biopsies or excisional surgery specimen. The mean patient age was 52 years (range, 20-80 years). The examinations included mammography and ultrasonography in all 130 patients. The final surgical histology was compared to preoperative biopsy diagnosis, and then factors associated with underestimation of malignancy were evaluated in univariate and multivariate analyses.

The preoperative histology was available for 63 patients. Benign papilloma had been identified by ductography in 34 patients and by preoperative biopsy in 48 patients. Mammography showed microcalcifications in 25 cases and nipple discharge was present in 59 patients. Malignancy was found on final histology in 8% of patients with initial diagnosis of benign papilloma. In this study group, age of more than 50 years, presence of nipple discharge and microcalcifications were found to be significantly related to the risk of malignancy (p=0.001, 0.05 and 0.02, respectively).

Since benign papilloma can be associated to malignancy at excisional biopsy, we still recommend surgical excision for papilloma especially when associated to identified risk factors of malignancy.