[Surgical treatment for intraductal proliferative lesions]

Intraductal proliferative lesions of the breast including benign, borderline and malignant diseases continue to be one of the most difficult diagnostic and therapeutic problems to the pathologist and surgeon. The optimal management should be done according to the different characteristics of the diseases. However, it is difficult to obtain the precise information of the individual disease before surgery. Selected ductolobular segmentectomy of the breast was performed in 73 patients who had been preoperatively diagnosed as having intraductal papilloma due to the clinical examinations. The specimen obtained from 25 patients were subjected to 3-dimensional (3-D) reconstruction analysis of their duct architectures. As the result, intraductal papilloma was divided into central papilloma and peripheral one. It revealed that none of the nine patients originating in the central duct had carcinoma and 6 of the 16 (37.5%) patients with peripheral papilloma coexisted with carcinoma in the terminal ductal-lobular units (TDLUs). This procedure is consisted of the total excision of affected ductolobular system. The favorable results is obtained in the cosmesis and breast feeding, and there is no recurrent case for the follow up period from 1 to 13 years.