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Jin Z, Al Qaysi N, Hanna M, Moses V, Spiguel L, Shaw C, Asirvatham JR. Surgical excision versus clinical follow-up: Outcomes of benign intraductal papillomas diagnosed on core needle biopsy. Am J Surg 2024; 233:114-119. [PMID: 38503684 DOI: 10.1016/j.amjsurg.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/24/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To compare outcomes between benign intraductal papillomas diagnosed on core need biopsy that were excised (BIP-E) versus those that were followed-up (BIP-F) at our institution. METHODS Patients were identified by an electronic data base search from January 2010 to October 2016. After exclusions, clinical, radiological and histologic variables were evaluated and biopsy and excision slides reviewed. RESULTS 110 BIP from 104 females were analyzed. 84 BIP were excised and 26 BIP were followed up (mean 43.3 months, range 7-93 months).11 patients in BIP-E group had atypia on excision. There were no statistically significant differences between BIP-E with atypia and BIP-E without, except for clinical presentation with pain/discomfort (p = 0.015) in the former. There were no true upgrades to malignancy in both groups on follow up. One patient from each group developed a new breast cancer distant from IP site after nearly 4 years of uneventful follow-up. CONCLUSION Clinical follow up is an oncologically safe alternative for radiologically concordant BIP. Excision may be considered if a diagnosis of atypia would impact surveillence and chemoprevention recommendations.
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Affiliation(s)
- Zhongbo Jin
- Department of Anatomic and Clinical Pathology, HCA Healthcare, USF Morsani College of Medicine, USA
| | - Nada Al Qaysi
- Department of Pathology, University of California, Davis, USA
| | - Mariam Hanna
- Department of Radiology, University of Florida, Gainesville, USA
| | - Viju Moses
- Division of Rheumatology, Department of Medicine, Baylor Scott and White Health, Temple, TX, USA
| | - Lisa Spiguel
- Department of Surgery, University of Florida, Gainesville, USA
| | - Christiana Shaw
- Department of Surgery, University of Florida, Gainesville, USA
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2
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Gillani M, Idress R, Afzal S, Khan M, Shahzad H, Sattar AK. Management of Breast Intraductal Papilloma Diagnosed on Core Needle Biopsy: Excision or Follow-up? Cureus 2024; 16:e54716. [PMID: 38523979 PMCID: PMC10960725 DOI: 10.7759/cureus.54716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Management of intraductal papillomas (IDPs) diagnosed on core needle biopsy (CNB) remains controversial. We report our experience of IDPs identified on CNB, our institutional rates of upgradation to atypia/malignancy as well as radiologic/pathologic features that may allow selection for surgery as well as those for safe observation. Methods The study is a retrospective review of patient records from 2012 to 2019, at a tertiary care hospital in Pakistan. Data was analyzed using Statistical Package for Social Sciences (SPSS), version 21.0 (IBM Corp., Armonk, NY). Associations between various patient factors were assessed using Pearson's chi-square test. Results This study included a total of 55 female patients with IDPs, with a mean age of 54.67 ± 15.57 years. On CNB, 69.1% (n = 38) of patients had IDP without atypia while 30.9% (n = 17) had IDP with atypia, with single IDPs being the most common lesions on excisional biopsy. Overall, of all CNB-diagnosed IDPs, only 4/55 (7.3%) demonstrated upgradation (3/4 to DCIS, 1/4 showed atypia) on excisional biopsy, and all these upgraded cases had failed to demonstrate atypia on initial CNB. Conclusion CNB-identified cases of IDPs are rarely upgraded on excision and thus routine excision in all cases may be unnecessary. Appropriate patient selection based on radiology-pathology findings should be done. Those with suspicious findings on imaging as well as those that demonstrate atypia on CNB must be excised.
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Affiliation(s)
- Mishal Gillani
- Department of Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Romana Idress
- Department of Histopathology, Aga Khan University Hospital, Karachi, PAK
| | - Shaista Afzal
- Department of Radiology, Aga Khan University Hospital, Karachi, PAK
| | - Maria Khan
- Department of Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Hania Shahzad
- Department of Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Abida K Sattar
- Department of Surgery, Aga Khan University Hospital, Karachi, PAK
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3
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Lou C, Wang W, Zhou B. Treatment Strategy for Breast Benign Intraductal Papilloma: A Meta-Analysis. J Environ Pathol Toxicol Oncol 2024; 43:39-49. [PMID: 38608144 DOI: 10.1615/jenvironpatholtoxicoloncol.2024052888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Currently, the optimal treatment approach for breast benign intraductal papilloma (IDP) diagnosed via biopsy remains uncertain. There is ongoing debate regarding the feasibility of clinical follow-up and the criteria for selective surgical excision. This study aims to conduct a meta-analysis to determine the rate of upgrade from breast benign IDP and identify predictive factors associated with the conversion of benign IDP to high-risk lesions or carcinoma, which could guide healthcare practitioners in selecting the appropriate clinical treatment strategy. We conducted a comprehensive search across multiple databases (PubMed, Web Of Science, Cochrane Library, and Embase) for studies published between 2012 and 2023 that evaluated upgrade rates and predictive factors of breast benign IDP diagnosed via biopsy. In addition, we included studies that reported on the clinical follow-up of patients with breast benign IDP. In total, 32 studies comprising 7371 cases of biopsy-diagnosed breast benign IDP were included. Among these cases, 720 demonstrated an upgrade to high-risk lesions or carcinoma, resulting in an upgrade rate of 6.94% [95% confidence interval (CI): 3.0-8.0%]. A subgroup of 1713 patients was clinically followed up, demonstrating an average follow-up duration of 30.95 months. Among them, 26 cases experienced an upgrade to high-risk lesions or carcinoma, yielding an upgrade rate of 1.51% (95% CI 0.00-2.00). Furthermore, we identified nine predictive factors associated with the upgrading of breast benign IDP, which included age at diagnosis, personal history of breast cancer, family history of breast cancer, multiple IDPs, lesion size ≥ 10 mm, palpable mass, calcification, and the presence of mass and asymmetry in mammographic findings. Although the conversion rate of breast benign IDP to high-risk lesions or carcinoma is relatively low, timely identification of predictive factors associated with benign IDP upgrades may help selecting the optimal clinical treatment strategy, such as surgery for patients with benign IDP presenting one or more predictive factors, while clinical follow-up for those without specific risk factors.
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Affiliation(s)
- Congkun Lou
- Comprehensive Cancer Center, Nanjing Tianyinshan Hospital, Nanjing 211100, China
| | - Wenhsin Wang
- Xiamen Keli Medical Beauty Clinic, Xiamen 361003, China
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4
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Tierney SN. Intraductal Papillomas. Surg Clin North Am 2022; 102:965-972. [DOI: 10.1016/j.suc.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Harbhajanka A, Gilmore HL, Calhoun BC. High-risk and selected benign breast lesions diagnosed on core needle biopsy: Evidence for and against immediate surgical excision. Mod Pathol 2022; 35:1500-1508. [PMID: 35654997 DOI: 10.1038/s41379-022-01092-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/09/2022]
Abstract
The vast majority of image-detected breast abnormalities are diagnosed by percutaneous core needle biopsy (CNB) in contemporary practice. For frankly malignant lesions diagnosed by CNB, the standard practice of excision and multimodality therapy have been well-defined. However, for high-risk and selected benign lesions diagnosed by CNB, there is less consensus on optimal patient management and the need for immediate surgical excision. Here we outline the arguments for and against the practice of routine surgical excision of commonly encountered high-risk and selected benign breast lesions diagnosed by CNB. The entities reviewed include atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, intraductal papillomas, and radial scars. The data in the peer-reviewed literature confirm the benefits of a patient-centered, multidisciplinary approach that moves away from the reflexive "yes" or "no" for routine excision for a given pathologic diagnosis.
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Affiliation(s)
- Aparna Harbhajanka
- Department of Pathology, Case Western University School of Medicine, Cleveland, OH, 44106, USA
| | - Hannah L Gilmore
- Department of Pathology, Case Western University School of Medicine, Cleveland, OH, 44106, USA
| | - Benjamin C Calhoun
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA.
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6
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Corbin H, Bomeisl P, Amin AL, Marshall HN, Gilmore H, Harbhajanka A. Upgrade Rates of Intraductal Papilloma with and without Atypia Diagnosed on Core Needle Biopsy and Clinicopathologic Predictors. Hum Pathol 2022; 128:90-100. [PMID: 35863513 DOI: 10.1016/j.humpath.2022.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
Surgical excision of breast intraductal papilloma (IDP) without atypia diagnosed on core needle biopsy (CNB) is controversial as the risk of upgrade to malignant lesions is not well established. This study investigates upgrade rates of benign and atypical IDP to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) and clinicopathologic predictors. We identified 556 cases of IDP diagnosed on CNB at a single institution from 2010-2020 after excluding patients with a history of breast carcinoma, ipsilateral high-risk lesion, radiologic/pathologic discordance, or less than 2 years of follow-up if no excision within one year. Of these, 97 biopsies were consistent with atypical IDP and 459 were benign IDP. Surgical excision was performed for 318 (57.2%), and the remaining 238 (42.8%) underwent active monitoring. The upgrade rate for IDP without atypia was 2/225 (0.9%; 1 DCIS and 1 IC). Of 93 surgically excised atypical IDPs, 19/93 (20.4%) upgraded (14 DCIS and 5 IC). Of 238 non-excised IDPs followed clinically (range 24-140 months, mean 60 months), there was no subsequent breast cancer diagnosed at the IDP site on follow-up. Mean age of patients was 56 yr±12.6sd without upgrade, 63 yr±10.6sd (p value=0.027) with DCIS, and 61 yr±10.8sd (p value=0.35) with IC. Atypical IDP was more likely to upgrade if biopsied by stereotactic guidance (8/19, 42.1% p=0.035). At our institution, we had an exceedingly low upgrade rate for benign IDP. Overall, patients with upgrade to DCIS were older. For atypical IDP, upgrade was seen in higher proportions of stereotactic biopsies.
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Affiliation(s)
- Haley Corbin
- Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Philip Bomeisl
- Department of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Amanda L Amin
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Holly N Marshall
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Hannah Gilmore
- Department of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Aparna Harbhajanka
- Department of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Noritake M, Yamada A, Yamanaka S, Utsunomiya D, Inoue T. Intraductal Papilloma With Carcinoma of the Breast Described by Dedicated Breast 18F-FDG PET. Clin Nucl Med 2022; 47:557-558. [PMID: 35143457 DOI: 10.1097/rlu.0000000000004086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
ABSTRACT Intraductal papilloma (IDP) is a benign tumor of the breast. However, IDP has been reported to show high uptake of 18F-FDG using whole-body PET. We experienced IDP with low-grade ductal carcinoma in situ using dedicated breast PET, which is more sensitive than whole-body PET. The 18F-FDG uptake of the whole tumor was high, and differentiation between the carcinoma and the residual benign lesion was difficult. This is the first report of IDP detected with dedicated breast PET. Diagnosis of IDP is sometimes controversial; papilloma may show glucose uptake similar to that of low-grade carcinoma.
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Affiliation(s)
| | - Akimitsu Yamada
- Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University
| | - Shoji Yamanaka
- Department of Pathology, Yokohama City University Hospital, Yokohama
| | | | - Tomio Inoue
- Advanced Medical Center, Shonan Kamakura General Hospital, Kamakura, Japan
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Woodard S, Zamora K, Allen E, Choe AI, Chan TL, Li Y, Khorjekar GR, Tirada N, Destounis S, Weidenhaft MC, Hartsough R, Park JM. Breast papillomas in the United States: single institution data on underrepresented minorities with a multi-institutional update on incidence. Clin Imaging 2022; 82:21-28. [PMID: 34768222 DOI: 10.1016/j.clinimag.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess the percentage of papillomas from all biopsies performed, comparing differences in patient age and race at a single institution. To assess trends in biopsied papillomas at institutions throughout the United States (US). METHODS This is a HIPPA-compliant IRB-approved single-institution (Southern1) retrospective review to assess race and age of all-modality-biopsied non-malignant papillomas as a percentage of all biopsies (percentage papillomas calculated as papilloma biopsies/all biopsies) from January 2012 to December 2019. To assess national variation, several academic or large referral centers were contacted to provide data regarding papilloma percentages, biopsy modalities, and trends in case numbers. Trends were estimated using the method of analysis of variance (ANOVA). Comparisons of differences in trends were assessed. RESULTS Southern1 institution demonstrated a significant association between race and percentage of papillomas (p < 0.0001). After adjustment for multiple comparisons with Bonferroni correction at 5% type I family error, the percentage of biopsied papillomas in Black and Asian patients remained significantly higher than in White patients (p < 0.0001 and p = 0.0032, respectively) using a Chi-square test. The regional variation in percentage of papillomas was found to be 3-9%. Southern1 institution showed a 7-year significant trend of increase in percentage of papillomas. Other institutions showed a decreasing trend (p < 0.05). CONCLUSION Black and Asian women had significantly higher papilloma percentages compared to white patients in our single institution review. This institution also showed a statistically significant trend of increasing percentage papillomas from 2012 to 2019. Multi-institutional survey found regional variation in percentage papillomas, ranging from 3% to 9%.
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Affiliation(s)
- Stefanie Woodard
- Department of Radiology, Breast Imaging and Intervention, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, United States of America.
| | - Kathryn Zamora
- Department of Radiology, Breast Imaging and Intervention, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, United States of America.
| | - Elizabeth Allen
- Department of Radiology, Breast Imaging and Intervention, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, United States of America.
| | - Angela I Choe
- Department of Radiology, Breast Imaging Section, Penn State Health Milton S. Hershey Medical Center, 30 Hope Dr Suite 1800, Hershey, PA 17033, United States of America.
| | - Tiffany L Chan
- UCLA Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095, United States of America.
| | - Yufeng Li
- Comprehensive Cancer Center, The University of Alabama at Birmingham, MT 644, 1717 11th Ave SI, Birmingham, AL 35294-4410, United States of America.
| | - Gauri R Khorjekar
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center and School of Medicine, 22 S Greene St, Baltimore MD-21201, United States of America.
| | - Nikki Tirada
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center and School of Medicine, 22 S Greene St, Baltimore MD-21201, United States of America.
| | - Stamatia Destounis
- Partner, Elizabeth Wende Breast Care (EWBC), Chair Clinical Research and Medical Outcomes EWBC, 170 Sawgrass Drive, Rochester, NY 14620, United States of America.
| | - Mandy C Weidenhaft
- Department of Radiology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, United States of America.
| | - Richard Hartsough
- Touro Infirmary Imaging Center, 1401 Foucher Street, New Orleans, LA 70115, United States of America
| | - Jeong Mi Park
- Department of Radiology, Breast Imaging and Intervention, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, United States of America.
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Alberty‐Oller JJ, Reyes S, Moshier E, Ru M, Weltz S, Santos A, Pisapati K, Port E, Jaffer S. Does previous history of cancer or atypia predict histologic upgrade for pure intraductal papillomas diagnosed via core biopsy? A study of 490 cases at a single institution. Cancer Rep (Hoboken) 2021; 5:e1481. [PMID: 34729946 PMCID: PMC8955065 DOI: 10.1002/cnr2.1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Management of pure intraductal papillomas (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial given highly variable rates of upgrade in the literature. AIM We sought to identify clinical and histologic factors that predict upgrade to atypia or malignancy in a large population. METHODS AND RESULTS A retrospective review was performed of all cases of pure IDP diagnosed on CNB and then surgically excised at a single institution from 2008 to 2018. Clinical, radiologic, and pathologic factors were compared in the no upgrade, upgrade to atypia, or upgrade to cancer groups. Univariate analysis was performed comparing no upgrade and upgrade to cancer or atypia. Four hundred and thirty nine patients were identified with a total of 490 IDP and a median age of 50 years (range 16-85). Of these patients, 54 (12.3%) were upgraded to atypia after surgical excision and five (1.1%) were upgraded to cancer. The presence of multiple papillomas in a single patient was a significant predictor of upgrade to cancer or atypia (p < .01), as well as age over ≥55 years (p < .01) and a prior history of cancer (p < .01). No other clinical, radiologic and histologic factors were found to be significant predictors of upgrade. 40/439 (9.1%) patients in the total cohort had prior history of cancer, and of these, 2/40 (5%) were found to have a new cancer after excision. CONCLUSIONS In patients with pure IDP on CNB, the upgrade rate to malignancy was 1.1%, while 12.3% were upgraded to atypia. The clinical significance of identifying atypia in a papilloma is unknown, especially in a patient with a prior history of atypia or cancer. However, the majority of patients who were upgraded to either atypia or cancer had no prior history of high-risk or malignant breast disease and are therefore considered true clinical upgrades. As such excision for IDP should be considered.
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Affiliation(s)
- J. Jaime Alberty‐Oller
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sylvia Reyes
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Erin Moshier
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Meng Ru
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sarah Weltz
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Antonio Santos
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kereeti Pisapati
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Elisa Port
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Shabnam Jaffer
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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10
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Brogi E, Krystel-Whittemore M. Papillary neoplasms of the breast including upgrade rates and management of intraductal papilloma without atypia diagnosed at core needle biopsy. Mod Pathol 2021; 34:78-93. [PMID: 33106592 DOI: 10.1038/s41379-020-00706-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 11/09/2022]
Abstract
Papillary neoplasms of the breast are a heterogeneous group of epithelial tumors nearly entirely composed of papillae. Their classification rests on the characteristics of the epithelium and the presence and distribution of the myoepithelial cells along the papillae and around the tumor. Papillary neoplasms of the breast can be diagnostically challenging, especially if only core needle biopsy (CNB) material is available. This review summarizes salient morphological and immunohistochemical features, clinical presentation, and differential diagnoses of papillary neoplasms of the breast. We include a contemporary appraisal of the upgrade rate to carcinoma (invasive carcinoma and ductal carcinoma in situ [DCIS]) and atypical hyperplasias in surgical excision specimens obtained following CNB diagnosis of papilloma without atypia, and a review of the available follow-up data in cases without immediate surgical excision.
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Affiliation(s)
- Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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11
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Moseley T, Desai B, Whitman GJ, Robinson EK, Saunders T, Gonzalez A, He H. Benign Breast Intraductal Papillomas Without Atypia at Core Needle Biopsies: Is Surgical Excision Necessary? Ann Surg Oncol 2020; 28:1347-1355. [PMID: 32860176 DOI: 10.1245/s10434-020-09061-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/08/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to determine the upgrade rate of image-guided core needle biopsy (CNB)-proven benign breast intraductal papillomas (IDPs) without atypia to high-risk benign lesions or malignancy after surgical excision. METHODS A retrospective database search at a single institution identified 102 adult female patients with benign breast IDPs without atypia diagnosed on imaging-guided CNBs who subsequently had surgical excisions between 2011 and 2016. Patient characteristics, imaging features, biopsy techniques, and the pathology reports from imaging-guided CNBs and subsequent surgical excisions were reviewed. The upgrade rate to malignancies or high-risk benign lesions was determined at the patient level. RESULTS The upgrade rate to malignancy was 2.9% (3/102), including two cases of ductal carcinoma in situ (DCIS) and one case of microinvasive (< 1 mm) ductal carcinoma arising from DCIS. The upgrade rate to high-risk benign lesions was 7.8% (8/102), with seven cases of atypical ductal hyperplasia and one case of atypical lobular hyperplasia. A personal history of breast cancer and a larger mean lesion size were significantly associated with an upgrade to malignancy (p < 0.05). CONCLUSIONS The management of benign breast IDPs without atypia detected on imaging-guided CNBs is controversial. Our results suggest risk stratification is important in approaching these patients. Although surgical excision should be considered for all benign breast IDPs without atypia, observation with serial imaging may be appropriate in selected low-risk patients. This approach will save many women from surgeries and decrease the cost of medical care.
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Affiliation(s)
- Tanya Moseley
- Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bella Desai
- Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX, 77030, USA
| | - Gary J Whitman
- Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily K Robinson
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tamara Saunders
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Anneliese Gonzalez
- Division of Oncology, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hongying He
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX, 77030, USA.
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12
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Kader T, Elder K, Zethoven M, Semple T, Hill P, Goode DL, Thio N, Cheasley D, Rowley SM, Byrne DJ, Pang JM, Miligy IM, Green AR, Rakha EA, Fox SB, Mann GB, Campbell IG, Gorringe KL. The genetic architecture of breast papillary lesions as a predictor of progression to carcinoma. NPJ Breast Cancer 2020; 6:9. [PMID: 32195332 PMCID: PMC7067788 DOI: 10.1038/s41523-020-0150-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/13/2020] [Indexed: 12/11/2022] Open
Abstract
Intraductal papillomas (IDP) are challenging breast findings because of their variable risk of progression to malignancy. The molecular events driving IDP development and genomic features of malignant progression are poorly understood. In this study, genome-wide CNA and/or targeted mutation analysis was performed on 44 cases of IDP, of which 20 cases had coexisting ductal carcinoma in situ (DCIS), papillary DCIS or invasive ductal carcinoma (IDC). CNA were rare in pure IDP, but 69% carried an activating PIK3CA mutation. Among the synchronous IDP cases, 55% (11/20) were clonally related to the synchronous DCIS and/or IDC, only one of which had papillary histology. In contrast to pure IDP, PIK3CA mutations were absent from clonal cases. CNAs in any of chromosomes 1, 16 or 11 were significantly enriched in clonal IDP lesions compared to pure and non-clonal IDP. The observation that 55% of IDP are clonal to DCIS/IDC indicates that IDP can be a direct precursor for breast carcinoma, not limited to the papillary type. The absence of PIK3CA mutations and presence of CNAs in IDP could be used clinically to identify patients at high risk of progression to carcinoma.
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Affiliation(s)
- Tanjina Kader
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia
| | - Kenneth Elder
- The Breast Service, The Royal Women’s Hospital, Fitzroy, VIC Australia
| | | | | | - Prue Hill
- Department of Anatomical Pathology, St Vincent’s Hospital, Fitzroy, VIC Australia
| | - David L. Goode
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia
| | - Niko Thio
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Dane Cheasley
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | | | | | - Jia-Min Pang
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Islam M. Miligy
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham and Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - Andrew R. Green
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham and Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - Emad A. Rakha
- Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham and Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | | | - G. Bruce Mann
- The Breast Service, The Royal Women’s Hospital, Fitzroy, VIC Australia
| | - Ian G. Campbell
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia
- Department of Clinical Pathology, University of Melbourne, Parkville, VIC Australia
| | - Kylie L. Gorringe
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia
- Department of Clinical Pathology, University of Melbourne, Parkville, VIC Australia
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