Investigation of Factors Affecting Histopathological Upgrade in Breast Papillary Lesions: A Single-Center Study

Breast papillary lesions are uncommon but clinically important due to their potential for histological upgrade. This study aimed to determine the factors that may influence histopathological upgrade in breast papillary lesions.

A retrospective review was conducted of female patients who underwent surgery for papillary lesions at Erciyes University Medical Faculty Hospital from 2010 onward. Upgrade was defined as a benign/low-risk lesion on biopsy found to be high risk or malignant after excision; downgrade referred to the opposite scenario. Statistical analyses were performed using SPSS 22.0 (chi-square test, p < 0.05). Associations were investigated between histopathological shift and variables including age, menopausal status, comorbidities, family history, palpable mass, symptom type, lesion laterality and quadrant, Breast Imaging Reporting and Data System (BI-RADS) category, microcalcification, breast density, echogenicity, lesion structure, contour, and biopsy method.

Among 199 patients (median age: 53 years), 46 (23.1%) experienced histopathological upgrade and 13 (6.5%) had a downgrade. Upgrade was significantly associated with menopausal status (p = 0.029), hypertension (p = 0.014), lesion laterality (p = 0.028), and presence of a palpable mass (p = 0.045). Downgrade was significantly related to symptom type (p = 0.028) and presence of microcalcifications (p = 0.033). While BI-RADS category was significantly associated with upgrade (p = 0.035), it did not influence downgrade (p = 0.492). Lesion size, biopsy technique, breast density, echogenicity, lesion structure, and contour showed no significant effect on upgrade or downgrade outcomes (p > 0.05).

In breast papillary lesions, menopause, certain comorbidities, and specific radiological factors (such as BI-RADS category and calcifications) may increase the risk of histopathological transition. These findings underscore the importance of a multidisciplinary approach in diagnosing and managing intraductal papillomas. Larger scale studies could further refine risk stratification, potentially reducing unnecessary surgeries while facilitating earlier identification of high-risk patients.