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1.
OBJECTIVE
Papillary breast cancer represents a rare and putatively more indolent subtype of breast cancer. Due to a paucity of data specific to the surgical management of papillary carcinoma, these malignancies are typically managed similarly to more common invasive ductal carcinoma, which includes surgical staging of the axillary nodes. We hypothesized that women with papillary carcinoma are less likely to have nodal metastasis and may, therefore, require less invasive surgery.
2. DESIGN
Retrospective review of all papillary carcinoma diagnosed and treated in an academic medical center between 1990-2012. Surgical management and pathologic results were documented.
3. SETTING
A tertiary care academic medical center.
4. PATIENTS OR OTHER PARTICIPANTS
Charts of patients diagnosed and treated for papillary carcinoma of the breast between 1990-2012 were reviewed. Patients with papillary DCIS, DCIS arising from a papillary lesion, and patients with invasive ductal carcinoma with papillary features were excluded.
5. INTERVENTION(S)
Surgical management and pathologic results for each patient were recorded and analyzed.
6. MAIN OUTCOME MEASURE(S)
Incidence of nodal involvement in women with true papillary carcinoma of the breast.
7. RESULTS
29 patients deemed eligible for the study. Average age 72.6 years. Average tumor size 1.8cm. 19/29 patients underwent axillary nodal sampling (3 dissections, 16 sentinel node biopsy). No positive nodes were identified in any patients. In contrast, for women with higher risk histology, over 20% of women with cancer of this size are expected to have nodal metastasis (p=0.007 between incidence rates of nodal positivity).
8. CONCLUSIONS
In women with true papillary carcinoma, the incidence of nodal metastasis is low. In well-selected patients, nodal staging and the co-morbidity related to this surgical procedure, may be avoided.