Surgical excision of intraductal breast papilloma diagnosed on core biopsy

The need for surgical excision of benign papillary lesions diagnosed on core biopsy remains debatable. This lack of consensus arises because although there is a possibility of histological underestimation, there are as yet no reliable predictors of malignancy. We therefore aimed to evaluate the incidence of histological underestimation in our practice, and to identify factors that predict for this, in order to reduce unnecessary surgery without missing out on possible malignancy.

Retrospective review of 106 patients diagnosed with a papillary lesion on percutaneous image-guided core biopsy was performed between 1 January 2005 and 31 December 2008. The presence of atypia on core biopsy and the presence of malignancy in the surgical specimen were correlated with standard clinical, radiological and pathological features.

Histological underestimation occurred in 15 of 81 patients (19%). Malignancy was more likely when atypia was present in the core biopsy (P= 0.04, OR 5.17). Otherwise, a final diagnosis of malignancy was not correlated with any clinical or radiological features (P > 0.05). The presence of atypia was also not correlated with any clinical or radiological features.

In our study, 19% of patients with a benign papillary lesion diagnosed on core biopsy were found to have atypical ductal hyperplasia or malignancy following surgery. In view of this, together with the absence of reliable predictive factors for malignancy, we recommend surgical excision of all papillary lesions diagnosed on core biopsy.