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Papillary lesions of the breast: To excise or observe?
Breast J. 2018 05; 24(3):350-355.BJ

Abstract

Papillary lesions of the breast range from benign to atypical to malignant. Although papillomas without frank cancer are benign, their management remains controversial. When a core needle biopsy of a lesion yields a diagnosis of intraductal papilloma with atypia, excision is generally recommended to rule out a concurrent malignant neoplasm. For intraductal papillomas without atypia, however, recommendations for excision versus observation are variable. The aims of this study are to evaluate the rate of concurrent malignancies for intraductal papilloma diagnosed on core needle biopsy and to assess the long-term risk of developing cancer after the diagnosis of a papillary lesion. This single institution retrospective study analyzed 259 patients that were diagnosed with intraductal papilloma (IDP) by core needle biopsy from 1995 to 2010. Patients were grouped by initial diagnosis into three groups (papilloma without atypia, papilloma with atypia, and papilloma with atypical duct hyperplasia or atypical lobular hyperplasia (ADH/ALH) and followed up for long-term outcomes. After a core needle biopsy showing IDP with atypia or IDP + ADH/ALH, surgical excision yielded a diagnosis of concomitant invasive or ductal in situ cancer in greater that 30% of cases. For intraductal papilloma without atypia, the likelihood of cancer was much lower. Moreover, even with excision, the finding of intraductal papilloma with atypia carries a significant risk of developing cancer long-term, and such patients should be followed carefully and perhaps should be considered for chemoprevention.

Authors+Show Affiliations

Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA.Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA.Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA.School of Medicine, Virginia Commonwealth University, Richmond, VA, USA. Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA. Massey Cancer Center, Richmond, VA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28845569

Citation

Khan, Sidrah, et al. "Papillary Lesions of the Breast: to Excise or Observe?" The Breast Journal, vol. 24, no. 3, 2018, pp. 350-355.
Khan S, Diaz A, Archer KJ, et al. Papillary lesions of the breast: To excise or observe? Breast J. 2018;24(3):350-355.
Khan, S., Diaz, A., Archer, K. J., Lehman, R. R., Mullins, T., Cardenosa, G., & Bear, H. D. (2018). Papillary lesions of the breast: To excise or observe? The Breast Journal, 24(3), 350-355. https://doi.org/10.1111/tbj.12907
Khan S, et al. Papillary Lesions of the Breast: to Excise or Observe. Breast J. 2018;24(3):350-355. PubMed PMID: 28845569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Papillary lesions of the breast: To excise or observe? AU - Khan,Sidrah, AU - Diaz,Adrian, AU - Archer,Kellie J, AU - Lehman,Rebecca R, AU - Mullins,Tiffany, AU - Cardenosa,Gilda, AU - Bear,Harry D, Y1 - 2017/08/27/ PY - 2016/09/01/received PY - 2017/02/01/revised PY - 2017/02/06/accepted PY - 2017/8/29/pubmed PY - 2019/3/12/medline PY - 2017/8/29/entrez KW - atypia KW - breast carcinoma KW - breast papilloma KW - core needle biopsy KW - papillary lesion SP - 350 EP - 355 JF - The breast journal JO - Breast J VL - 24 IS - 3 N2 - Papillary lesions of the breast range from benign to atypical to malignant. Although papillomas without frank cancer are benign, their management remains controversial. When a core needle biopsy of a lesion yields a diagnosis of intraductal papilloma with atypia, excision is generally recommended to rule out a concurrent malignant neoplasm. For intraductal papillomas without atypia, however, recommendations for excision versus observation are variable. The aims of this study are to evaluate the rate of concurrent malignancies for intraductal papilloma diagnosed on core needle biopsy and to assess the long-term risk of developing cancer after the diagnosis of a papillary lesion. This single institution retrospective study analyzed 259 patients that were diagnosed with intraductal papilloma (IDP) by core needle biopsy from 1995 to 2010. Patients were grouped by initial diagnosis into three groups (papilloma without atypia, papilloma with atypia, and papilloma with atypical duct hyperplasia or atypical lobular hyperplasia (ADH/ALH) and followed up for long-term outcomes. After a core needle biopsy showing IDP with atypia or IDP + ADH/ALH, surgical excision yielded a diagnosis of concomitant invasive or ductal in situ cancer in greater that 30% of cases. For intraductal papilloma without atypia, the likelihood of cancer was much lower. Moreover, even with excision, the finding of intraductal papilloma with atypia carries a significant risk of developing cancer long-term, and such patients should be followed carefully and perhaps should be considered for chemoprevention. SN - 1524-4741 UR - https://www.unboundmedicine.com/medline/citation/28845569/Papillary_lesions_of_the_breast:_To_excise_or_observe L2 - https://doi.org/10.1111/tbj.12907 DB - PRIME DP - Unbound Medicine ER -