Upgrade Rate and Predictive Factors Associated With Breast Papillary Lesions on Core Biopsy: A Canadian Experience

Background: Papillary lesions of the breast are a heterogeneous group, encompassing a wide range of lesions. The histologic distinction between papillary breast lesions remains challenging, especially on core biopsy specimens. Aim: This study aimed to determine the rate of upgrade to atypia or malignancy of biopsy-proven papillary lesions on surgical follow-up and to assess for factors associated with an upgrade in Greater Vancouver, BC, Canada. Materials and Methods: This is a retrospective population-based study of all breast papillary lesions diagnosed on core biopsy between 2017 and 2019 in the Fraser Health Authority in Greater Vancouver, Canada. Patients were retrieved from the laboratory information system. Patient demographics, histopathologic, and radiologic findings were analyzed. Results: A total of 269 specimens from 269 patients (mean 61.1 years), including 265 female and 4 male patients, were included in the study. Of the 269 specimens, 129 (48%) were intraductal papillomas and 140 (52%) were atypical papillary lesions. The overall upgrade rate among papillomas was 11.6% (15 of 129) on final excision. The mean age of patients diagnosed with papilloma on core biopsy was significantly younger than those with atypical papillary lesions (55.6 vs 66.1 years, P < .0001). Lesion size in patients with papillomas on core biopsy was significantly smaller than those with atypical papillary lesions (11.1 vs 15.1 mm, P = .001). The upgrade rates in patients <55 and ≥55 years were 4.9% and 13.2%. Size (P = .004) and atypia on core biopsy (P = .009) were significantly associated with upgrade. Older age (>55 years) (OR =  5.3, 95% CI: 1.04-27.08) was an independent predictor of upgrade among papillomas. Size, location, and Breast Imaging-Reporting and Data System (BI-RADS) radiologic categories in our study were not associated with predicting the upgrade of papillomas. Conclusion: Our data suggest that the risk of upgrade to atypia or malignancy is sufficient to warrant the excision of benign papillomas of any size in patients aged ≥55 years. In patients younger than 55 years, observation with close clinical and radiological follow-up without surgery may be sufficient. Our findings also support surgical excision of papillomas diagnosed on core biopsy when associated with atypia.

[1]  P. Tan,et al.  Papillary neoplasms of the breast—reviewing the spectrum , 2021, Modern Pathology.

[2]  J. Chun,et al.  Upgrade Rate of Intraductal Papilloma Diagnosed on Core Needle Biopsy in a Single Institution. , 2020, Human pathology.

[3]  Tanya W. Moseley,et al.  Benign Breast Intraductal Papillomas Without Atypia at Core Needle Biopsies: Is Surgical Excision Necessary? , 2020, Annals of Surgical Oncology.

[4]  M. Hur,et al.  Factors associated with disease upgrading in patients with papillary breast lesion in core-needle biopsy. , 2020, Gland surgery.

[5]  Dan Zhou,et al.  Treatment and Outcome of 341 Papillary Breast Lesions , 2019, World Journal of Surgery.

[6]  J. Darbinian,et al.  Benign Papillary Breast Mass Lesions: Favorable Outcomes with Surgical Excision or Imaging Surveillance , 2019, Annals of Surgical Oncology.

[7]  S. Sener,et al.  Are we overtreating intraductal papillomas? , 2018, The Journal of surgical research.

[8]  Lars J. Grimm,et al.  Concordant, non-atypical breast papillomas do not require surgical excision: A 10-year multi-institution study and review of the literature. , 2018, Clinical imaging.

[9]  B. Calhoun,et al.  Breast Cancer Risk Associated With Benign Intraductal Papillomas Initially Diagnosed on Core Needle Biopsy , 2018, Clinical breast cancer.

[10]  Sung-Won Kim,et al.  The Management Strategy of Benign Solitary Intraductal Papilloma on Breast Core Biopsy , 2017, Clinical breast cancer.

[11]  Melissa P. Murray,et al.  Breast intraductal papillomas without atypia in radiologic‐pathologic concordant core‐needle biopsies: Rate of upgrade to carcinoma at excision , 2016, Cancer.

[12]  Min Jung Kim,et al.  Asymptomatic Benign Papilloma Without Atypia Diagnosed at Ultrasonography-Guided 14-Gauge Core Needle Biopsy: Which Subgroup can be Managed by Observation? , 2016, Annals of Surgical Oncology.

[13]  J. Palazzo,et al.  Intraductal Papilloma with Benign Pathology on Breast Core Biopsy: To Excise or Not? , 2015, Annals of Surgical Oncology.

[14]  Masayuki Yoshida,et al.  Intraductal papillomas on core biopsy can be upgraded to malignancy on subsequent excisional biopsy regardless of the presence of atypical features , 2015, Pathology international.

[15]  S. Raza,et al.  Papilloma on Core Biopsy: Excision vs. Observation , 2015, Annals of Surgical Oncology.

[16]  J. Thomison,et al.  Papillomas of the Breast 15 mm or Smaller: 4-Year Experience in a Community-Based Dedicated Breast Imaging Clinic , 2015, Annals of Surgical Oncology.

[17]  A. Giuliano,et al.  Management of Papillary Lesions of the Breast: Can Larger Core Needle Biopsy Samples Identify Patients Who May Avoid Surgical Excision? , 2013, Annals of Surgical Oncology.

[18]  D. Chan,et al.  Papillary breast lesions diagnosed by core biopsy require complete excision. , 2012, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[19]  Catherine M. Appleton,et al.  Pathologic outcomes of nonmalignant papillary breast lesions diagnosed at imaging-guided core needle biopsy. , 2012, Radiology.

[20]  E. Tan,et al.  Surgical excision of intraductal breast papilloma diagnosed on core biopsy , 2012, ANZ journal of surgery.

[21]  D. Noh,et al.  Papillary Lesions Initially Diagnosed at Ultrasound-guided Vacuum-assisted Breast Biopsy: Rate of Malignancy Based on Subsequent Surgical Excision , 2011, Annals of Surgical Oncology.

[22]  H. Kang,et al.  Risk Factors for Malignancy in Benign Papillomas of the Breast on Core Needle Biopsy , 2010, World Journal of Surgery.

[23]  C. Chen,et al.  Risk Factors Associated with Conversion from Nonmalignant to Malignant Diagnosis After Surgical Excision of Breast Papillary Lesions , 2009, Annals of Surgical Oncology.

[24]  S. Jaffer,et al.  Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy , 2009, Cancer.

[25]  S. Raza,et al.  Management of Intraductal Papillomas of the Breast: An Analysis of 129 Cases and Their Outcome , 2009, Annals of Surgical Oncology.

[26]  E. Cho,et al.  Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy? , 2008, Breast.

[27]  W. Wood,et al.  Surgical Follow-Up and Clinical Presentation of 142 Breast Papillary Lesions Diagnosed by Ultrasound-Guided Core-Needle Biopsy , 2008, Annals of Surgical Oncology.

[28]  N. Arora,et al.  Clinicopathologic features of papillary lesions on core needle biopsy of the breast predictive of malignancy. , 2007, American journal of surgery.

[29]  R. Vierkant,et al.  An Analysis of Breast Cancer Risk in Women With Single, Multiple, and Atypical Papilloma , 2006, The American journal of surgical pathology.

[30]  J. Cangiarella,et al.  Papillary lesions of the breast at percutaneous core-needle biopsy. , 2006, Radiology.

[31]  N. Sneige,et al.  Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy , 2004, Modern Pathology.

[32]  G. MacGrogan,et al.  Central atypical papillomas of the breast: a clinicopathological study of 119 cases , 2003, Virchows Archiv.

[33]  A. Douglas-Jones,et al.  Diagnostic difficulty arising from displaced epithelium after core biopsy in intracystic papillary lesions of the breast , 2002, Journal of clinical pathology.

[34]  S. Schnitt,et al.  Nonmalignant Lesions in Breast Core Needle Biopsies: To Excise or Not to Excise? , 2002, The American journal of surgical pathology.

[35]  Min Kyoon Kim,et al.  Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: Scoring system for predicting malignancy. , 2018, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[36]  J. Youk,et al.  Benign papilloma without atypia diagnosed at US-guided 14-gauge core-needle biopsy: clinical and US features predictive of upgrade to malignancy. , 2011, Radiology.

[37]  S. T. Chen,et al.  The management of papillary lesion of the breast by core needle biopsy. , 2009, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[38]  D. Noh,et al.  Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study , 2009, European Radiology.

[39]  T. Hijaz,et al.  Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy. , 2007, Radiology.