Clinical Characteristics of the Diagnosis and Treatment in Patients with Papillary Lesions of the Breast

Lee, Do Kyung; Lee, Jin Yong

Abstract

BACKGROUND: Papillary lesions of the breast exhibit bloody nipple discharge, often with no evidence of a palpable tumor. These lesions occasionally present some difficult diagnostic and therapeutic problems as they may be histologically benign, borderline or malignant. The types of surgery should be selected according to the different lesion characteristics. A favorable result of appropriate surgery is no recurrence.
METHODS
The authors performed a retrospective study of 60 patients treated for the papillary lesions of the breast over the period from January 1990 to July 1998 at Inje University Pusan Paik Hospital. The study examined clinical characteristics by comparative analysis of clinical features, diagnostic methods (mammogram, ultrasound, galactogram & fine needle aspiration cytology) and surgical procedures among the various types of papillary lesions of the breast diagnosed histologically.
RESULTS
The patients with a papillary carcinoma or papillomatosis were all older than the mean age of 45 for the 60 patients. Nipple discharges were most frequent in multiple central papilloma patients & intraductal papilloma patients. The incidence of nipple discharge alone was 26.1% in intraductal papilloma patients. Palpable masses were most frequent in the patients with a papillary carcinoma, intraductal papilloma, or papillomatosis. Ultrasound and galactograms had the highest sensitivity (90.9%, 87.5%) in all the patients with papillary lesions. Galactograms had the highest sensitivity (89%) in the patients with nipple discharge alone. The diagnostic methods with the highest sensitivity according to the type of papillary lesion were the galactogram (84.6%) for intraductal papillomas; ultrasound (100%) for multiple central papillomas; galactogram (100%), ultrasound (100%), and FNAC (100%) in papillomatosis; and the mammogram (100%) and ultrasound (100%) for papillary carcinomas. Breast cancers (DCIS, ipsilateral/contralateral invasive ductal carcinoma, papillary carcinoma) or ADH were associated with 14 cases (23.3%) of papillary lesions of the breast, in particular, 8 cases (42.1%) of papillomatosis. The most common surgical procedures were excisional biopsies & microdochectomies for intraductal papillomas, microdochectomies for multiple central papillomas, excisional biopsies & major duct excisions for papillomatosis, and mastectomies for papillary carcinomas. The incidence of postsurgical residual lesions and the recurrence were 10% & 1.7% in all the patients with papillary lesions of the breast, and were especially high in patients with papillomatosis.
CONCLUSIONS
1) Ultrasonography & galactography seem to be the most useful diagnostic methods for papillary lesions of the breast. 2) Major duct excision is recommended as an effective treatment for papillomatosis.