Are Histologically Benign Papillarly Lesions of the Breast Associated with Increased Risk for Developing In Situ or Invasive Carcinoma? A Follow-Up Study of 302 Patients
H Arabi, S Bandyopadhyay, Z Nahleh, M Ibrahim, B Albashiti, Q Ahmed, W Sakr, R Ali-Fehmi. Emory University, Atlanta, GA; Wayne State University, Detroit, MI; Karmanos Cancer Institute, Detroit, MI
Background: There is abundant evidence that atypical papillary lesions of the breast are associated with a significant risk of carcinoma and need to be excised. The clinical significance of diagnosing a 'benign” papilloma is controversial. The objectives of this study was to define the risk associated with papillomas and atypical papillomas in breast biopsy specimens.
Design: Using our institutional database, we identified 415 consecutive breast biopsies indicating the presence of a papillary lesion between 1997 and 2000. Follow up data were obtained from our institutional record and the national SEER registry. The cases were classified into three pathological categories: benign papillomas with no atypia, atypical papillomas (papillomas with atypical architectural/cytological features or papilloma with coexistent atypical ductal hyperplasia), and papilloma with coexistent DCIS. Statistical correlation of these categories with patient follow up was determined using Chi-square test.
Results: Three hundred and two of the 415 papillary lesions (75%), had histologic follow up with subsequent breast sampling. Mean age at diagnosis was 53 years (19- 93 years). The median follow-up was 106 months (0-155 months). Two hundred and fifty six cases were classified as benign papilloma with no atypia and 29 as atypical papilloma. Seventeen patients who had papilloma with coexistent DCIS served as control. Overall, on follow-up, 17 of the 302 patients (5.6%), were diagnosed with ductal carcinoma in situ (8 cases) or invasive carcinoma (9 cases). For the 17 patients with papilloma and concurrent DCIS initially, 5 (29%), showed persistent DCIS with a subset harboring invasive carcinoma on follow up sampling. DCIS and /or invasive carcinoma was identified on follow up in 2 of 29 (7%) patients with the initial diagnosis of atypical papilloma and in 10 of 256 (3.9%), patients who were initially diagnosed with benign papilloma. (p=0.005).
Conclusions: Our data suggest that the increased risk for developing DCIS/invasive cancer associated with atypical papillary lesions of the breast extends to patients with papilloma without atypia.
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 13, Monday Morning