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Related Experiment Video

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Intraductal Delivery to the Rabbit Mammary Gland
06:30

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Are we overtreating intraductal papillomas?

Sayee Kiran1, Young Ju Jeong2, Maria E Nelson1

  • 1Division of Breast, Endocrine and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center and Los Angeles County + USC Medical Center, University of Southern California, Los Angeles, California.

The Journal of Surgical Research
|October 4, 2018
PubMed
Summary

Intraductal papillomas (IDPs) diagnosed via core needle biopsy (CNB) rarely upgrade to malignancy. Watchful surveillance may be suitable for IDPs without atypia or personal breast cancer history, avoiding overtreatment.

Keywords:
AtypiaBreast cancerBreast neoplasmCore needle biopsyIntraductal papilloma

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Area of Science:

  • Breast pathology
  • Surgical oncology
  • Diagnostic imaging

Background:

  • Management of intraductal papillomas (IDPs) diagnosed on core needle biopsy (CNB) is debated.
  • Routine excision of IDPs may lead to overtreatment.

Purpose of the Study:

  • To evaluate the upgrade rate of IDPs diagnosed on CNB.
  • To identify factors predicting for malignant upgrade.

Main Methods:

  • Retrospective review of patients treated with IDP excision (2009-2016).
  • Analysis of CNB specimens for IDPs with and without atypia.
  • Evaluation of final pathology for malignant upgrade.

Main Results:

  • Overall upgrade rate was 7.3% (1.3% invasive cancer, 2.7% DCIS, 3.3% ADH).
  • IDPs without atypia had a 3% upgrade rate to malignancy.
  • Personal history of breast cancer and MRI-guided biopsy predicted upgrade.

Conclusions:

  • IDPs on CNB have a low risk of occult malignancy.
  • Watchful surveillance is a reasonable option for IDPs without atypia or personal breast cancer history.