Should Microscopic Incidental Intraductal Papillomas of the Breast Diagnosed on Core Needle Biopsy Be Excised?
S Jaffer, C Nagi, I Scordi-Bello, IJ Bleiweiss. The Mount Siani Medical Center, New York, NY
Background: Most authors recommend excision of intraductal papillomas (IDP) diagnosed on core needle biopsy (CNB). This leads to the question of whether excision is necessary for incidental intraductal papillomas (iIDP) on CNB.
Design: Using the pathology computerized data base we retrospectively identified 46 iIDP diagnosed on CNB from 1/2000 to 12/2008. Clinical, radiologic and pathologic information was gathered and correlated. All CNB were reviewed to confirm the diagnosis of iIDP, and excision specimens reviewed when available.
Results: Of the 46 patients, follow up information was available in only 38. The age of these patients ranged from 39 to 82 (mean= 48years). Most iIDP were diagnosed by mammotome CNB(36 cases). 33 cases were performed for calcifications (ca++) with the following indications: clustered=21, new=4, pleomorphic=3, increasing=3, indeterminant=2,. The correlating diagnoses included: fibrocystic changes (FCC) with calcium phosphate=18, calcium oxalate=10, fibroadenoma with ca++=5. The 3 masses were: 2 cases of cystic papillary apocrine metaplasia and 1 fibroadenoma. 1 case was diagnosed via ultrasound and was a fibroadenoma. The last case was diagnosed via MRI and was cystic papillary apocrine metaplasia. In all cases the IDPs were <=0.2cm, were not associated with ca++, and were incidental to them or the underlying mass. 14 patients underwent excision, whereas the remaining 24 have remained radiologically stable for over 12 months. The excision specimen findings were: FCC=8 and IDP=6. With the exception of 1 case, all the IDP persisted to be incidental. In this solitary case, the ca++ were described as pleomorphic and corresponded to FCC ca++ on CNB. However on excision, residual pleomorphic ca++ on mammogram correlated with ca++ in both FCC and IDP. No cases were upstaged on excision to atypical duct hyperplasia or intraductal or invasive carcinoma.
Conclusions: With the exception of 1 case, all iDP diagnosed on CNB were either completely excised or remained incidental. The exception occurred due to sampling error and accounted for the change from an iIDP on CNB to one that was associated with ca++ on excision. Given the complete lack of upstaging, our recommendation is not to excise iIDP diagnosed on CNB provided the index lesion has been adequately sampled and radiologic follow up is maintained.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 37, Wednesday Morning