Papilloma on core biopsy: excision vs. observation

Area of Science:

• Oncology
• Pathology
• Radiology

Background:

• Intraductal papillomas (IPs) are common breast lesions with varied presentations.
• Excision is standard for palpable lesions, atypical cells, or nipple discharge to rule out cancer.
• Management of asymptomatic IPs without atypia remains controversial.

Purpose of the Study:

• To evaluate the upgrade rate to malignancy for intraductal papillomas (IPs) diagnosed via core biopsy (CBx).
• To compare outcomes between IPs with and without cellular atypia.
• To inform clinical decision-making regarding the necessity of surgical excision for IPs.

Main Methods:

• Retrospective review of 97 patients with IPs on core biopsy (CBx) between 2005-2013.
• All patients underwent surgical excision with subspecialty breast pathology review.
• Upgrade rates to ductal carcinoma in situ (DCIS) or invasive cancer were recorded and analyzed.

Main Results:

• Among 52 atypical IPs, 11 (21%) upgraded to DCIS.
• Among 45 IPs without atypia, 3 (6.7%) upgraded to cancer (2 DCIS, 1 invasive).
• Excluding palpable lesions, the upgrade rate for non-atypical IPs was 2.2%, with no malignancy found in non-palpable, non-discordant cases.

Conclusions:

• Intraductal papillomas (IPs) without atypia on core biopsy (CBx) have a low upgrade rate to malignancy, especially when non-palpable and without radiographic/pathologic discordance.
• Surgical excision may not be routinely necessary for these specific cases.
• Further prospective studies are recommended to refine upgrade rate estimates for non-atypical IPs.