J Breast Cancer.  2016 Dec;19(4):410-416. 10.4048/jbc.2016.19.4.410.

Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy

• Hong YR
• Song BJ
• Jung SS
• Kang BJ
• Kim SH
• Chae BJ

• KMID: 2362927
• DOI: http://doi.org/10.4048/jbc.2016.19.4.410

Abstract

PURPOSE
Intraductal papilloma (IDP) is a benign breast disease with malignant potential, for which complete surgical excision is usually recommended. The aim of the present study was to investigate predictive factors for upgrading patients with a benign papillary lesion (BPL).
METHODS
This study was an observational study using a prospectively collected cohort. In total, 13,049 patients who underwent a core needle biopsy (CNB) for a breast lesion between January 2009 and May 2015 were enrolled. We reviewed all patients with pathologically confirmed BPL from a CNB.
RESULTS
Surgical treatment was performed for 363 out of a total of 592 lesions. According to the pathological differences, the lowest upgrade rate was shown in IDP without atypia (without atypia, 6.0%; with atypia, 26.8%; papillary neoplasm, 31.5%; p<0.001). The univariate analysis showed that, in IDP without atypia, the age at diagnosis, size of BPL on ultrasonography, and density on mammography were associated with upgrading. The multivariate analysis revealed that age >54 years and lesion size >1 cm were significantly associated with upgrade to malignancy (odds ratio [OR]=4.351, p=0.005 and OR=4.236, p=0.001, respectively).
CONCLUSION
The indications for surgical treatment can be defined as age >54 years and mass size >1 cm, even in IDP without atypia in the CNB results; this also includes cases of IDP with atypia or papillary neoplasm. Therefore, we suggest that close observation without surgery is sufficient for younger women with a small IDP without atypia.

Keyword

Atypia; Biopsy; Breast neoplasms; Intraductal papilloma; Large core needle

MeSH Terms

Biopsy
Biopsy, Large-Core Needle*
Breast Diseases
Breast Neoplasms
Breast*
Cohort Studies
Diagnosis
Female
Humans
Mammography
Multivariate Analysis
Observational Study
Papilloma, Intraductal
Prospective Studies
Ultrasonography

Figure

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  Figure 1 The schematic diagram outlines the process for selecting eligible cases for analysis.F/u=follow-up; BI-RADS=Breast Imaging Reporting and Data System; IDP=intraductal papilloma.

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  Figure 2 Distribution of intraductal papilloma depending on the age at the diagnosis. Patients age was divided into 10-year (A) or 20-year (B) intervals. Blue color represents upgrade to malignancy, and red color represents absence of upgrade, by comparing the pathologic results before and after surgery.

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