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Management of Benign Intraductal Solitary Papilloma Diagnosed on Core Needle Biopsy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The purpose of this study was to determine whether surgical excision of benign solitary intraductal papillomas (BSIP) diagnosed by core needle biopsy (CNBx) without an associated high-risk lesion and concordant with imaging is justified.

Methods

A review of all papillary lesions diagnosed by CNBx from January 2003 to June 2010 was performed. Available histologic and radiologic materials were evaluated in a blinded fashion by three pathologists and three dedicated breast radiologists, respectively, to assess for concordance. The papillary lesions were designated as benign, atypical, or malignant. There were 16 BSIPs excluded because of an adjacent high-risk lesion or same-quadrant ipsilateral cancer. All immediate and delayed excisional specimens were reviewed. Clinical and radiologic data were recorded.

Results

A total of 299 papillary lesions diagnosed on CNBx and concordant with imaging were identified. Of these, 240 (80 %) were classified as benign, 49 (16 %) atypical, and 10 (3 %) malignant. After exclusions, 77 of 224 women in our study cohort (34 %) underwent surgical excision with no atypical or malignant upgrades. Of the remaining 147 women diagnosed with a BSIP on CNBx, 47 (32 %) were lost to follow-up and 100 (68 %) were observed. All 100 observed patients had stable imaging findings at follow-up (4.8–93.8 months, mean 36.0 months).

Conclusions

The likelihood of diagnosing atypia or malignancy after surgical excision of a BSIP diagnosed on CNBx without associated high-risk lesion or ipsilateral quadrant malignancy is extremely low. For this distinct subset of patients with a BSIP, these data justify close imaging follow-up, rather than surgical excision.

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Acknowledgment

Many thanks to Natalie S. Campbell and Benjamin J. Barrett for their help with data analysis.

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Authors and Affiliations

  1. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Ryan E. Swapp MD, Carol Reynolds MD & Daniel W. Visscher MD

  2. Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA

    Katrina N. Glazebrook MB, ChB, Katie N. Jones MD & Hannah M. Brandts MD

  3. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Tina J. Hieken MD

Authors
  1. Ryan E. Swapp MD
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  2. Katrina N. Glazebrook MB, ChB
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  3. Katie N. Jones MD
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  4. Hannah M. Brandts MD
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  5. Carol Reynolds MD
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  6. Daniel W. Visscher MD
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  7. Tina J. Hieken MD
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Correspondence to Ryan E. Swapp MD.

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Swapp, R.E., Glazebrook, K.N., Jones, K.N. et al. Management of Benign Intraductal Solitary Papilloma Diagnosed on Core Needle Biopsy. Ann Surg Oncol 20, 1900–1905 (2013). https://doi.org/10.1245/s10434-012-2846-9

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  • DOI: https://doi.org/10.1245/s10434-012-2846-9

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