Benign papillomas without atypia diagnosed on core needle biopsy: experience from a single institution and proposed criteria for excision

Abstract

Background: The management of benign papilloma (BP) without atypia identified on breast core needle biopsy (CNB) is controversial. In this study, we determined the upgrade rate to malignancy for BPs without atypia diagnosed on CNB and whether there are factors associated with upgrade.

Methods: Through our pathology database search, we studied 80 BPs without atypia identified on CNB from 80 patients from 1997 to 2010, including 30 lesions that had undergone excision and 50 lesions that had undergone ≥ 2 years of radiologic follow-up. Associations between surgery or upgrade to malignancy and clinical, radiologic, and pathologic features were analyzed.

Results: Mass lesions, lesions sampled by ultrasound-guided CNB, and palpable lesions were associated with surgical excision. All 3 upgraded cases were mass lesions sampled by ultrasound-guided CNB. None of the lesions with radiologic follow-up only were upgraded to malignancy. The overall upgrade rate was 3.8%. None of the clinical, radiologic, or histologic features were predictive of upgrade.

Conclusion: Because the majority of patients can be safely managed with radiologic surveillance, a selective approach for surgical excision is recommended. Our proposed criteria for excision include pathologic/radiologic discordance or sampling by ultrasound-guided CNB without vacuum assistance when the patient is symptomatic or lesion size is ≥ 1.5 cm.

Keywords: Breast; Core needle biopsy; Criteria; Papilloma; Upgrade.

Figure 1

Hematoxylin and Eosin Stains of Biopsy and Excision Specimens of the 3 Papilloma Cases Upgraded to Malignancy. (A–C) First Case. (A) Biopsy Specimen Showing a Papilloma. (B) No Residual Papilloma at the Biopsy Site on Excision. (C) Ductal Carcinoma in Situ (DCIS) Surrounding the Biopsy Site on Excision. (D and E) Second Case. (D) Biopsy Specimen Showing a Papilloma. (E) DCIS Involving Papilloma on Excision (Right Side). (F–H) Third Case. (F) Biopsy Specimen Showing a Papilloma. (G) Papilloma on Excision, Showing no Atypia. (H) DCIS Surrounding Papilloma on Excision. (Original Magnification: A, C–H, ×100; B, ×40.)