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Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: Scoring system for predicting malignancy.
Eur J Surg Oncol. 2018 Jan; 44(1):53-58.EJ

Abstract

BACKGROUND

The management of benign intraductal papilloma diagnosed on core needle biopsy (CNB) remains unclear. This study was designed to evaluate factors predicting malignancy in patients diagnosed with benign papilloma without atypia at ultrasound-guided CNB and to develop a scoring system predicting malignancy based on clinical, radiological and pathological factors on further excisional biopsy.

METHODS

The study enrolled patients diagnosed with benign papillomas (including benign and atypical papillary lesions) at CNB. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy.

RESULTS

A total of 520 CNBs were diagnosed with benign or atypical papilloma. Of these, 452 were benign papilloma without atypia. Of the 250 lesions subsequently excised surgically from 234 women, 17 (6.8%) were diagnosed with malignancy. Multivariate analysis revealed that bloody nipple discharge, size on imaging ≥15 mm, BI-RADS≥4b, peripheral location and palpability were independent predictors of malignancy. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.947 (95% CI: 0.913-0.981, p < 0.001) and a negative predictive value was 100%. In a validation set of 62 patients, an area under the ROC curve was 0.926 (95% CI: 0.857-0.995, p < 0.001).

CONCLUSIONS

A scoring system predicting malignancy in patients diagnosed by CNB with benign papilloma without atypia was developed. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Ahn SK
Breast & Endocrine Cancer Center, Dept of Surgery, Kangnam Sacred Heart Hospital, Hallym University, 91, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, South Korea. Electronic address: Sooahn79@gmail.com.
Han W
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
Moon HG
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
Kim MK
Department of Surgery, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
Noh DY
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
Jung BW
Breast & Endocrine Cancer Center, Dept of Surgery, Kangnam Sacred Heart Hospital, Hallym University, 91, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, South Korea.
Kim SW
Department of Surgery, Daerim St. Mary's Hospital, 657, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, South Korea.
Ko E
Breast Surgery, Oncology Center, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates. Electronic address: koeun02@gmail.com.

MeSH

AdultAgedAged, 80 and overBiopsy, Large-Core NeedleBreast NeoplasmsFemaleFollow-Up StudiesHumansImage-Guided BiopsyMastectomyMiddle AgedNeoplasm StagingPapillomaROC CurveRetrospective StudiesTime FactorsUltrasonography, MammaryYoung Adult

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

29174198

Citation

Ahn, Soo Kyung, et al. "Management of Benign Papilloma Without Atypia Diagnosed at Ultrasound-guided Core Needle Biopsy: Scoring System for Predicting Malignancy." European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, vol. 44, no. 1, 2018, pp. 53-58.
Ahn SK, Han W, Moon HG, et al. Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: Scoring system for predicting malignancy. Eur J Surg Oncol. 2018;44(1):53-58.
Ahn, S. K., Han, W., Moon, H. G., Kim, M. K., Noh, D. Y., Jung, B. W., Kim, S. W., & Ko, E. (2018). Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: Scoring system for predicting malignancy. European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 44(1), 53-58. https://doi.org/10.1016/j.ejso.2017.10.214
Ahn SK, et al. Management of Benign Papilloma Without Atypia Diagnosed at Ultrasound-guided Core Needle Biopsy: Scoring System for Predicting Malignancy. Eur J Surg Oncol. 2018;44(1):53-58. PubMed PMID: 29174198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: Scoring system for predicting malignancy. AU - Ahn,Soo Kyung, AU - Han,Wonshik, AU - Moon,Hyeong-Gon, AU - Kim,Min Kyoon, AU - Noh,Dong-Young, AU - Jung,Bong-Wha, AU - Kim,Sung-Won, AU - Ko,Eunyoung, Y1 - 2017/11/13/ PY - 2017/07/08/received PY - 2017/09/21/revised PY - 2017/10/10/accepted PY - 2017/11/28/pubmed PY - 2018/4/25/medline PY - 2017/11/28/entrez KW - Benign papilloma KW - Intraductal papilloma without atypia KW - Scoring system SP - 53 EP - 58 JF - European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology JO - Eur J Surg Oncol VL - 44 IS - 1 N2 - BACKGROUND: The management of benign intraductal papilloma diagnosed on core needle biopsy (CNB) remains unclear. This study was designed to evaluate factors predicting malignancy in patients diagnosed with benign papilloma without atypia at ultrasound-guided CNB and to develop a scoring system predicting malignancy based on clinical, radiological and pathological factors on further excisional biopsy. METHODS: The study enrolled patients diagnosed with benign papillomas (including benign and atypical papillary lesions) at CNB. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy. RESULTS: A total of 520 CNBs were diagnosed with benign or atypical papilloma. Of these, 452 were benign papilloma without atypia. Of the 250 lesions subsequently excised surgically from 234 women, 17 (6.8%) were diagnosed with malignancy. Multivariate analysis revealed that bloody nipple discharge, size on imaging ≥15 mm, BI-RADS≥4b, peripheral location and palpability were independent predictors of malignancy. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.947 (95% CI: 0.913-0.981, p < 0.001) and a negative predictive value was 100%. In a validation set of 62 patients, an area under the ROC curve was 0.926 (95% CI: 0.857-0.995, p < 0.001). CONCLUSIONS: A scoring system predicting malignancy in patients diagnosed by CNB with benign papilloma without atypia was developed. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate. SN - 1532-2157 UR - https://www.unboundmedicine.com/medline/citation/29174198/Management_of_benign_papilloma_without_atypia_diagnosed_at_ultrasound_guided_core_needle_biopsy:_Scoring_system_for_predicting_malignancy_ DB - PRIME DP - Unbound Medicine ER -