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Are we overtreating papillomas diagnosed on core needle biopsy?
Amy E Cyr1, Deborah Novack, Kathryn Trinkaus
1Department of Surgery, Washington University School of Medicine, Campus Box 8109, 660 South Euclid Avenue, Saint Louis, MO, USA. cyra@wudosis.wustl.edu
Annals of Surgical Oncology
|November 4, 2010
Summary
Core needle biopsy (CNB) of breast papillomas without atypia may require excision, as 24% upgrade, half to malignancy. Delayed excision of these benign papillomas can lead to malignancy detection.
Area of Science:
- Oncology
- Pathology
- Surgical Breast Disease
Background:
- Core needle biopsy (CNB) is standard for diagnosing breast papillomas.
- Excision is recommended for atypical papillomas due to high malignancy upgrade rates.
- Management of non-atypical papillomas on CNB remains unclear.
Purpose of the Study:
- To identify factors associated with pathology upgrade in breast papillomas diagnosed by CNB.
- To evaluate the upgrade rate of non-atypical papillomas upon surgical excision.
Main Methods:
- Retrospective review of 193 breast papillomas diagnosed via CNB over 10 years.
- Exclusion of lesions with atypia or malignancy on initial CNB.
- Comparison of outcomes between surgically excised and non-excised papilloma groups.
Main Results:
- Twenty-four percent of non-atypical papillomas upgraded on excision, with 50% of these being malignant.
- No significant association found between upgrade and clinical factors, location, or biopsy technique.
- Two non-excised papillomas enlarged and were subsequently upgraded to malignancy upon excision.
Conclusions:
- Surgical excision of breast papillomas diagnosed by CNB, even without atypia, reveals significant upgrade rates.
- Early excision may be warranted to detect malignancy, often at early stages (0 or I).
- Delayed excision in non-atypical cases carries a risk of malignancy detection upon eventual surgical intervention.