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Objective:
Intraductal papillomas (IDP) are common in evaluating breast masses. Decision to remove lesions with atypia or carcinoma is straightforward. The excision of IDP without atypia is less clear. This study attempts to characterize the rate of upgrade upon excision of lesions with IDP on core needle biopsy (CNB).
Design:
Retrospective review of patients 1/1/2000 to 12/31/2010 with CNB containing IDP.
Setting:
University based, multidisciplinary breast center.
Patients:
344 patients with CNB specimens showing IDP identified via electronic medical record, 97 of these underwent surgical excision.
Main Outcome Measures:
Results of CNB were compared to final pathology. The number of benign lesions that were upgraded to malignant was noted. Distance from the nipple (DFN) was calculated to determine if peripheral lesions were more suspicious.
Results:
97 patients underwent surgical excision, 42 (43.3%) had no atypia on CNB, 45 (46.4%) contained atypia on CNB, 7 (7.2%) contained carcinoma in situ (CIS) and 3 (3.1%) harbored invasive cancer on CNB.
In those with no atypia on CNB, 14 (33.3%) had atypia on excision, and 4 (9.5%) showed carcinoma
(DFN) was known in 33 of 42 cases. 15 were upgraded, 8 (53.3%) were &lt 3 CMFN, and 7 (46.7%) were &gt 3 CMFN. Bloody discharge was noted in 6 of the 42 cases, 4 (16.7%) in the non-atypia group after excision, and 2 (14.3%) in the atypia group.
Conclusions:
IDP without atypia on CNB had an upgrade of histologic diagnosis in 42.9%. Carcinoma was in 9.5% of benign CNB. DFN and discharge did not predict final pathology. Excision should be considered in all patients with CNB with IDP at all locations regardless of discharge, and absence of atypia.