Benign breast papilloma: Is surgical excision necessary?

Area of Science:

• Oncology
• Pathology
• Surgical Oncology

Background:

• Current standard of care involves surgical excision for all breast papillomas.
• Recent studies indicate low rates of malignancy upgrade after excision.

Purpose of the Study:

• To determine the upgrade rate to malignancy in patients diagnosed with benign papilloma without atypia on core biopsy.
• To evaluate the safety of observation as an alternative to surgical excision for these cases.

Main Methods:

• Retrospective review of a prospectively maintained database from a tertiary referral symptomatic breast unit (July 2008-July 2018).
• Inclusion criteria: benign intraductal papilloma on core biopsy. Exclusion criteria: malignancy/atypia on core biopsy, history of breast cancer, or predisposing genetic mutations.
• Final cohort: 138 patients after exclusions.

Main Results:

• Upgrade to malignancy (ductal carcinoma in situ or invasive disease) occurred in 2.4% of excisions (3/124 patients).
• Upgrade to other high-risk lesions was observed in 12.1% (15/124 patients).
• Benign papilloma was confirmed in 81.5% (100/124 patients) post-excision.

Conclusions:

• Patients with benign papilloma without atypia on core biopsy have a low risk of upgrade to malignancy.
• Observation may be a safe alternative to surgical excision for select patients.
• Further research is needed to identify specific patient groups suitable for conservative management.