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Keating N, Cevik J, Hopkins D, Lippey J. Malignant upgrade rate and associated clinicopathologic predictors for concordant intraductal papilloma without atypia: A systematic review and meta-analysis. J Surg Oncol 2024; 129:1025-1033. [PMID: 38305061 DOI: 10.1002/jso.27592] [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: 10/17/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
Previously reported upgrade rates for benign breast intraductal papilloma (IDP) are widely variable. However, many previous studies have failed to consider radiologic-pathologic discordance of lesions. This review aims to synthesize malignant upgrade data for benign, concordant IDP at surgical excision. Thirteen studies were included in our meta-analysis. The pooled estimate for percentage underestimation of carcinoma was 1.4% (95% CI: 0.8%-2.0%). We conclude that these lesions can be safely managed by active surveillance.
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Affiliation(s)
- Niamh Keating
- Department of Breast Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jevan Cevik
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Hopkins
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jocelyn Lippey
- Department of Breast Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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2
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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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Rella R, Romanucci G, Arciuolo D, Scaldaferri A, Bufi E, Croce S, Caulo A, Tommasini O. Multiple Papillomas of the Breast: A Review of Current Evidence and Challenges. J Imaging 2022; 8:jimaging8070198. [PMID: 35877642 PMCID: PMC9315766 DOI: 10.3390/jimaging8070198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: To conduct a review of evidence about papillomatosis/multiple papillomas (MP), its clinical and imaging presentation, the association between MP and malignancy and the management strategies that follow. Methods: A computerized literature search using PubMed and Google Scholar was performed up to January 2021 with the following search strategy: “papilloma” OR “intraductal papilloma” OR “intraductal papillary neoplasms” OR “papillomatosis” OR “papillary lesion” AND “breast”. Two authors independently conducted a search, screening and extraction of data from the eligible studies. Results: Of the 1881 articles identified, 29 articles met the inclusion criteria. The most common breast imaging methods (mammography, ultrasound) showed few specific signs of MP, and evidence about magnetic resonance imaging were weak. Regarding the association between MP and malignancy, the risk of underestimation to biopsy methods and the frequent coexistence of MP and other high-risk lesions needs to be taken into consideration. Results about the risk of developing breast carcinoma of patients affected by MP were inconsistent. Conclusions: MP is a challenge for all breast specialists, and familiarity with its features is required to make the correct diagnosis. Further studies are needed to evaluate the factors to take into account to plan management, time of follow-up and imaging methods.
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Affiliation(s)
- Rossella Rella
- UOC Diagnostica per Immagini, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122 Rome, Italy; (S.C.); (A.C.); (O.T.)
- Correspondence: ; Tel.: +39-06-56482353
| | - Giovanna Romanucci
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37142 Verona, Italy;
| | - Damiano Arciuolo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Dipartimento di Patologia Umana, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Assunta Scaldaferri
- Seno Clinic, Unità di Senologia Casa di Cura privata Villa Mafalda, Via Monte delle Gioie, 5, 00199 Roma, Italy;
| | - Enida Bufi
- UOC di Diagnostica per Immagini ed Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Roma, Italy;
| | - Sebastiano Croce
- UOC Diagnostica per Immagini, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122 Rome, Italy; (S.C.); (A.C.); (O.T.)
| | - Andrea Caulo
- UOC Diagnostica per Immagini, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122 Rome, Italy; (S.C.); (A.C.); (O.T.)
| | - Oscar Tommasini
- UOC Diagnostica per Immagini, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122 Rome, Italy; (S.C.); (A.C.); (O.T.)
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Taghipour Zahir S, Aminpour S, Jafari-Nedooshan J, Rahmani K, SafiDahaj F. Comparative study of breast core needle biopsy (CNB) findings with ultrasound BI-RADS subtyping. POLISH JOURNAL OF SURGERY 2022; 95:1-6. [PMID: 36805305 DOI: 10.5604/01.3001.0015.8480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b> Introduction:</b> Given the high prevalence of breast cancer, developing quick and accessible diagnostics solutions is critical. The BIRADS classification is a reliable method for assessing and estimating the risk of malignancy in breast lesions. </br></br> <b>Aim:</b> The aim of this study was to compare the results of core needle biopsy of breast lesions and sonographic findings based on the BIRADS category in Yazd. </br></br> <b>Materials and methods:</b> This retrospective analytical study was done on all core needle biopsy specimens referred to Mortaz hospital, Yazd, Iran from 2010 to 2019. Demographic data such as age, laterality of the lesion, BIRADS category, and pathology reports were extracted from patients' hospital folders. Data were analyzed by SPSS version 21. P < 0.05 was considered statistically significant. </br></br> <b>Results:</b> In total, 514 cases with a mean age of 43.9 9.4 years were studied. Among them, 104 cases (20.2%) were malignant and 410 cases (79.8%) were benign. The most common benign and malignant lesions were fibroadenoma (24.9%), and infiltrative ductal carcinoma (83.7%) respectively. The most common BIRADS was class 4A (54.9%). Patients with benign lesions were mostly in the 3rd and 4th decade of life, while malignant lesions were more in the 4th and 5th decades, and this difference was statistically significant (P = 0.001). The correlation between ultrasound diagnoses (BIRADS) and pathology findings was statistically significant (P < 0.001). </br></br> <b>Conclusion</b>: Based on the results, there is a significant correlation between ultrasound outcomes according to BIRADS and pathology results, and the radiology-pathology accordance, owing to its high accuracy, can be very helpful in correctly diagnosing, monitoring, and managing the lesion.
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Affiliation(s)
| | - Sara Aminpour
- International Campus, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Jamal Jafari-Nedooshan
- Department of Surgery, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Detailed Morphologic Evaluation of Breast Papillary Lesions on Core Biopsy Is Critical for Accurate Classification and Clinical Management: The Experience of an Academic Institute. Clin Breast Cancer 2021; 22:e552-e557. [PMID: 34998709 DOI: 10.1016/j.clbc.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Distinguishing between a breast intraductal papilloma and a papillary lesion with atypia or malignancy can be very challenging on core biopsy. There has been a long ongoing debate over whether or not it is necessary for breast papillary lesions diagnosed on core biopsies to be surgically excised, and the upgrading rate after excision varies. METHOD AND/OR RESULT This study was carried out in a subspecialized academic pathology department, with well-formed criteria established among the faculty for the categorization of breast papillary lesions, with emphasis on the morphology evaluation of cellular features. A total of 320 breast core biopsies with follow-up excisions were identified. Of these, 286 cases had concordant results between the biopsy and excision, giving a concordance rate of 89.4%, with 98% concordance (143/146) in benign papilloma, 100% (111/111) in papillary carcinoma, and 51% (32/63) in papilloma with atypia. Of the upgraded cases, two were upgraded from benign to atypical, 11 from atypia to malignancy, and only one from benign to malignant. The overall average upgrading rate was 4.4% (14/320), with the critical upgrading (from benign to atypia or malignancy) rate of 0.94% (3/320). Downgrading was only identified in the group of papilloma with atypia, with 20 of 63 cases downgraded to benign papilloma on excision. CONCLUSION Our study indicates that surgical excision may not be necessary for all papillary lesions after detailed evaluation of the morphology on core biopsies. Assessing the morphological features of the epithelial cells is critical for the accurate classification and clinical management of papillary lesions.
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Zhang H, Sun Y, Zhang J, Wang S. Breast Imaging Reporting and Data System Classification for Central-Type Intra-Ductal Papillary Masses: Current Problems and Evaluation of Modified Parameters. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:960-966. [PMID: 33455809 DOI: 10.1016/j.ultrasmedbio.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/15/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
The Breast Imaging Reporting and Data System (BI-RADS) standards have limitations regarding classifying and managing central intra-ductal papillary masses. Changes to the standards are necessary to provide early and effective treatment. To summarize the ultrasonographic imaging features of central mammary ductal papillary masses, this retrospective study included 56 participants. In identifying benign versus malignant lesions, the most significant indicators were angular edges and the long diameter of the tumor parallel to the duct. In the comparison of diagnostic efficacy for central mammary ductal tumors, the post-operative pathologic malignant upgrade rate of BI-RADS was 33.3%, and that of the new standard criteria was 14.2%. The angle of the wall of the tumor relative to the duct was most helpful. When BI-RADS is used to evaluate a papillary mass in a central duct, it is more accurate when the tumor is parallel to the duct than parallel to the skin.
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Affiliation(s)
- Hui Zhang
- Department of Ultrasound Diagnosis, Peking University Third Hospital, Beijing, China
| | - Yan Sun
- Department of Ultrasound Diagnosis, Peking University Third Hospital, Beijing, China
| | - Jianlun Zhang
- Department of Ultrasound Diagnosis, Peking University Third Hospital, Beijing, China
| | - Shumin Wang
- Department of Ultrasound Diagnosis, Peking University Third Hospital, Beijing, China.
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7
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Ma Z, Arciero CA, Styblo TM, Wang H, Cohen MA, Li X. Patients with benign papilloma diagnosed on core biopsies and concordant pathology-radiology findings can be followed: experiences from multi-specialty high-risk breast lesion conferences in an academic center. Breast Cancer Res Treat 2020; 183:577-584. [PMID: 32705378 DOI: 10.1007/s10549-020-05803-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND To determine whether patients with benign papilloma diagnosed on core biopsy can be spared from surgery. METHODS We prospectively reviewed 150 consecutive core biopsy-diagnosed papilloma cases at a multi-specialty high-risk breast lesion conference to determine whether surgical excision was necessary. Of these 150 cases, 148 had concordant radiologic-pathologic features. Six were excluded due to lack of the first imaging follow-up until analysis. 112 were benign papillomas; 17 were papillomas involved by atypical ductal hyperplasia (atypical papilloma); 6 papillomas had ADH in adjacent tissue but not involving the papilloma; 2 papillomas were involved by atypical lobular hyperplasia (ALH); and 5 papillomas had ALH in adjacent tissue. Two were radiology-pathology (rad-path) discordant. RESULTS Thirty-nine of the 112 benign papillomas were excised with no upgrade to carcinoma; 73 were followed with no disease progression during follow-up (185-1279 days). Fifteen of 17 atypical papillomas were surgically excised with 4 (26.7%) upgraded to carcinoma. Four of the 6 patients with ADH adjacent to a benign papilloma underwent excision with 2 upgrades to carcinoma. None of the patients with papilloma, which was either involved by ALH or had ALH in adjacent tissue had upgrade or disease progression during follow-up (204-1159 days). Finally, the two cases with discordant path-rad discordant were excised with no upgrade. CONCLUSIONS Our data confirm that rad-path concordant benign papillomas diagnosed on core biopsy do not require surgery. It also supports the value of a formal multi-specialty review of all benign papilloma cases to create a consensus management plan.
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Affiliation(s)
- Zhongliang Ma
- Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | | | | | - Haibo Wang
- Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Michael A Cohen
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road, Atlanta, GA, USA.
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Road, Atlanta, GA, 30322, USA.
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8
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Li X, Aho M, Newell MS, Clifford K, Patel JG, Jou S, Cohen MA. Papilloma diagnosed on core biopsies has a low upgrade rate. Clin Imaging 2019; 60:67-74. [PMID: 31864203 DOI: 10.1016/j.clinimag.2019.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/01/2019] [Accepted: 10/11/2019] [Indexed: 11/26/2022]
Abstract
CONTEXT Surgical excision of benign intraductal papillomas (IDP) diagnosed on core needle biopsy (CNB) remains controversial. OBJECTIVE To examine the upgrade rate of IDPs diagnosed at core needle biopsy to carcinoma at surgical excision. DESIGN We identified 188 consecutive IDPs diagnosed at CNB from 2011 to 2016 with subsequent surgical excision. Radiologic, clinical, and histologic features were evaluated and correlated with upgrade rate at surgical excision. RESULTS Two of the 188 IDPs (1.1%) were upgraded to ductal carcinoma in situ or invasive carcinoma at excision. Features associated with upgrade rate include patient age (P = .03), largest size of papilloma on a single core at CNB (P = .04), and the presence of additional masses noted at ultrasound (P = .03). CONCLUSIONS Our study demonstrated a low 1.1% upgrade rate of surgically excised benign, concordant papillomas with no atypia or concurrent ipsilateral malignancy originally diagnosed on core biopsy. This data suggests that observation may be appropriate for radiologic-pathologic concordant benign IDPs diagnosed at CNB.
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Affiliation(s)
- Xiaoxian Li
- Department of Pathology, Emory Healthcare, Atlanta, GA, USA
| | - Michael Aho
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, GA, USA.
| | - Mary S Newell
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, GA, USA
| | - Kelly Clifford
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, GA, USA
| | - Jay G Patel
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, GA, USA
| | | | - Michael A Cohen
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, GA, USA
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9
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Fuentes JAP, Martínez CEM, Casadiego AKR, Freites VFA, Marín VAA, Castellano ACR. Papillary breast lesions diagnosed by percutaneous needle biopsy: management approach. Ecancermedicalscience 2019; 13:902. [PMID: 30915160 PMCID: PMC6390833 DOI: 10.3332/ecancer.2019.902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Indexed: 11/29/2022] Open
Abstract
Papillary breast lesions are a heterogeneous group of neoplasms of diverse imagenological, clinical and morphological presentation that display different behaviour, prognosis and, therefore, controversial diagnosis and management. The aim of this study is to propose an algorithm for the management of mammary lesions.
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10
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Grimm LJ, Bookhout CE, Bentley RC, Jordan SG, Lawton TJ. Concordant, non-atypical breast papillomas do not require surgical excision: A 10-year multi-institution study and review of the literature. Clin Imaging 2018; 51:180-185. [PMID: 29859481 DOI: 10.1016/j.clinimag.2018.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/12/2018] [Accepted: 04/24/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Non-atypical papillomas (NAPs) diagnosed on core needle biopsy (CNB) frequently undergo surgical excision due to highly variable upstaging rates. The purpose of this study is to document our dual-institution upgrade rates of NAPs diagnosed on core needle biopsy and review the upgrade rates reported in the literature. MATERIALS AND METHODS Following IRB approval, CNB results from Duke University (7/1/2004-6/30/2014) and the University of North Carolina Chapel Hill (1/1/04-6/30/2013) were reviewed to identify non-atypical papillomas. All cases with surgical excision or 2 years of imaging follow up were included. In addition, a literature review identified 60 published studies on upgrades of NAPs diagnosed at CNB. Cases in our cohort and the published literature were reviewed for confounding factors: [1] missing radiologic-pathologic concordance and/or discordance, [2] papillomas included with high-risk lesions, [3] high risk lesions counted as upgrades, [4] review by a nonspecialized breast pathologist, and [5] cancer incidentally detected. RESULTS Of the 388 CNBs in our dual-institution cohort, 136 (35%) patients underwent surgical excision and 252 (65%) patients had imaging follow up. After controlling for confounders, no cancers (0/388) were found at surgical excision or during follow up imaging. The literature review upstaging rate was 4.0% (166/4157) but 1.8% (4/227) after excluding studies with confounders. The combined upstaging rate from the literature and this study was 0.6% (4/615). CONCLUSION The upstaging rate for CNB diagnosed NAPs was 0% in our cohort and 0.6% overall after adjusting for confounders. This low rate does not warrant reflexive surgical excision and diagnostic imaging follow up should be discretionary.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University, DUMC Box 3808, Durham, NC 27710, USA.
| | - Christine E Bookhout
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, 101 Manning Dr, Cb #7525, Chapel Hill, NC 27514, USA
| | - Rex C Bentley
- Department of Pathology, Duke University, DUMC Box 3712, Durham, NC 27710, USA
| | - Sheryl G Jordan
- Department of Radiology, University of North Carolina at Chapel Hill, 430 Waterstone Drive, First Floor, Hillsborough, NC 27278, USA
| | - Thomas J Lawton
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
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Shear-Wave Elastography for the Differential Diagnosis of Breast Papillary Lesions. PLoS One 2016; 11:e0167118. [PMID: 27893857 PMCID: PMC5125677 DOI: 10.1371/journal.pone.0167118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of shear-wave elastography (SWE) for the differential diagnosis of breast papillary lesions. METHODS This study was an institutional review board-approved retrospective study, with a waiver of informed consent. A total of 79 breast papillary lesions in 71 consecutive women underwent ultrasound and SWE prior to biopsy. Ultrasound features and quantitative SWE parameters were recorded for each lesion. All lesions were surgically excised or excised using an ultrasound-guided vacuum-assisted method. The diagnostic performances of the quantitative SWE parameters were compared using the area under the receiver operating characteristic curve (AUC). RESULTS Of the 79 lesions, six (7.6%) were malignant and 12 (15.2%) were atypical. Orientation, margin, and the final BI-RADS ultrasound assessments were significantly different for the papillary lesions (p < 0.05). All qualitative SWE parameters were significantly different (p < 0.05). The AUC values for SWE parameters of benign and atypical or malignant papillary lesions ranged from 0.707 to 0.757 (sensitivity, 44.4-94.4%; specificity, 42.6-88.5%). The maximum elasticity and the mean elasticity showed the highest AUC (0.757) to differentiate papillary lesions. CONCLUSION SWE provides additional information for the differential diagnosis of breast papillary lesions. Quantitative SWE features were helpful to differentiate breast papillary lesions.
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12
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Seely JM, Verma R, Kielar A, Smyth KR, Hack K, Taljaard M, Gravel D, Ellison E. Benign Papillomas of the Breast Diagnosed on Large-Gauge Vacuum Biopsy compared with 14 Gauge Core Needle Biopsy - Do they require surgical excision? Breast J 2016; 23:146-153. [DOI: 10.1111/tbj.12702] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jean M. Seely
- Department of Medical Imaging; The Ottawa Hospital; University of Ottawa; Ottawa Ontario Canada
| | - Raman Verma
- The Ottawa Hospital; Ottawa Ontario Canada
- University of Ottawa; Ottawa Ontario Canada
| | - Ania Kielar
- The Ottawa Hospital; Ottawa Ontario Canada
- University of Ottawa; Ottawa Ontario Canada
- Royal Victoria Hospital; Barrie Ontario Canada
| | - Karl R. Smyth
- The Ottawa Hospital; Ottawa Ontario Canada
- University of Ottawa; Ottawa Ontario Canada
| | | | - Monica Taljaard
- Clinical Epidemiology Program; Ottawa Hospital Research Institute; Ottawa Ontario Canada
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa Ontario Canada
| | - Denis Gravel
- Department of Pathology; The Ottawa Hospital; Ottawa Ontario Canada
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13
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Foley NM, Racz JM, Al-Hilli Z, Livingstone V, Cil T, Holloway CMB, Romics L, Matrai Z, Bennett MW, Duddy L, Nofech-Mozes S, Slodkowska E, Mallon EA, Dawson N, Roche T, Relihan N, Hill ADK, Redmond HP, Corrigan MA. An International Multicenter Review of the Malignancy Rate of Excised Papillomatous Breast Lesions. Ann Surg Oncol 2015; 22 Suppl 3:S385-90. [PMID: 26240010 DOI: 10.1245/s10434-015-4773-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Papillary lesions of the breast are a relatively rare, but heterogeneous group ranging from benign to atypical and malignant. Debate exists regarding the optimal management of these lesions. In the absence of more accurate risk-stratification models, traditional management guidelines recommend surgical excision, despite the majority of lesions proving benign. This study sought to determine the rate of malignancy in excised breast papillomas and to elucidate whether there exists a population in which surgical excision may be unnecessary. METHODS A multicenter international retrospective review of core biopsy diagnosed breast papillomas and papillary lesions was performed between 2009 and 2013, following institutional ethical approval. Patient demographics, histopathological, and radiological findings were recorded. All data was tabulated, and statistical analysis performed using Stata. RESULTS A total of 238 patients were included in the final analysis. The age profile of those with benign pathology was significantly younger than those with malignant pathology (p < 0.001). Atypia on core needle biopsy was significantly associated with a final pathological diagnosis of malignancy (OR = 2.73). The upgrade rate from benign core needle biopsy to malignancy on the final pathological sample was 14.4 %; however, only 3.7 % had invasive cancer. CONCLUSIONS This international dataset is one of the largest in the published literature relating to breast papillomas. The overall risk of malignancy is significantly associated with older age and the presence of atypia on core needle biopsy. It may be possible to stratify higher-risk patients according to age and core needle biopsy findings, thereby avoiding surgery on low-risk patients.
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Affiliation(s)
- N M Foley
- Breast Research Centre, Cork University Hospital, Cork, Ireland.
| | - J M Racz
- Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada
| | - Z Al-Hilli
- Department of Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - V Livingstone
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - T Cil
- Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada
| | - C M B Holloway
- Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada
| | - L Romics
- Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK
| | - Z Matrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - M W Bennett
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - L Duddy
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - S Nofech-Mozes
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - E Slodkowska
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - E A Mallon
- Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK
| | - N Dawson
- Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK
| | - T Roche
- Department of Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - N Relihan
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - A D K Hill
- Department of Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - H P Redmond
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - M A Corrigan
- Breast Research Centre, Cork University Hospital, Cork, Ireland
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Outcomes of benign breast papillomas diagnosed at image-guided vacuum-assisted core needle biopsy. Clin Imaging 2015; 39:576-81. [PMID: 25691147 DOI: 10.1016/j.clinimag.2015.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/29/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the upgrade rate of benign papillomas diagnosed at image-guided vacuum-assisted core needle biopsy (VACNB) and to compare our results with the summarized literature. MATERIALS AND METHODS A database search was performed to identify patients older than 18 years of age with benign papillomas diagnosed at VACNB between 2004 and 2013. A total of 199 papillomas in 184 patients were identified. Clinical, imaging, and pathological features for each were analyzed. Patients who were subsequently diagnosed with malignancy at the site of papilloma, either at surgical excision or upon imaging follow-up, were compared with those not upgraded. Upgrade was defined as a diagnosis of invasive carcinoma or ductal carcinoma in situ (DCIS). RESULTS Of 199 papillomas, 110 (55.3%) were diagnosed at ultrasound-guided VACNB, 78 (39.2%) were diagnosed at stereotactic-guided VACNB, and 11 (5.5%) were diagnosed at magnetic resonance imaging-guided VACNB. Surgical excision was performed for 89 (44.7%), and the remaining 110 (55.3%) underwent imaging follow-up. Two patients were subsequently diagnosed with invasive carcinoma and 4 were found with DCIS. The upgrade rate across both groups was 3% (6 of 199). Masses with calcifications (P=.001) and smaller needle gauge at VACNB (P=.02) had a significant association with upgrade. CONCLUSION Benign papillomas diagnosed with VACNB demonstrated a 3% upgrade rate to malignancy, which is similar to the 2.9% upgrade rate calculated by compiling applicable published literature. Conservative management with imaging follow-up as opposed to surgical excision may be appropriate in cases where an initial diagnosis of benign papilloma is made with VACNB. Benign papillomas associated with calcifications on imaging should be considered for surgical excision given their increased association with malignancy.
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Benign papillomas without atypia diagnosed on core needle biopsy: experience from a single institution and proposed criteria for excision. Clin Breast Cancer 2013; 13:439-49. [PMID: 24119786 DOI: 10.1016/j.clbc.2013.08.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/03/2013] [Accepted: 08/26/2013] [Indexed: 11/22/2022]
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.
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