Papillomas on Core Needle Biopsy: Analysis of 88 Cases.
Anupma Nayak, Michael Z Gilcrease, Lavinia P Middleton, Selin Carkaci, Jinxia Zhang, Nour Sneige, Lei Huo. The University of Texas M.D. Anderson Cancer Center, Houston
Background: Although excision of breast intraductal papillomas with atypia is generally recommended, the clinical management of papillomas without atypia diagnosed on core needle biopsy (CNB) is controversial. This study aims to evaluate such lesions and correlate their clinical, radiological and histologic features with findings at excision or clinico-radiological follow-up.
Design: The computer database of our Department of Pathology was searched for papillary lesions on CNB. Exclusion criteria included non- availability of histologic material for review, concurrent diagnosis of ductal carcinoma in situ (DCIS)/invasive carcinoma in the ipsilateral breast, presence of atypical ductal hyperplasia or lobular neoplasia within or outside of the papilloma in the same CNB, or incidental papillomas. The resulting 88 cases were the subjects of the study, including 36 cases from 2003 to 2010 with subsequent surgical excision and 52 cases from 1998 to 2008 with ≥2 years of clinico-radiological follow-up. Slides of core biopsies were reviewed to confirm the diagnosis, and multiple clinical, radiological and histologic features were evaluated.
Results: The presence of nipple discharge, hypoechoeic mass on ultrasonography, and incomplete removal of the targeted lesion by CNB were significantly associated with those lesions that underwent excision versus clinicoradiological follow-up (p=0.0449; p=0.0025; p=0.0001, Fisher's exact test). Of the 36 cases with excision, 8 (22.2%) had an upgrade on excision (invasive papillary carcinoma, grade 2, 3.0 cm, 1 case; invasive ductal carcinoma, grade 1, 0.9 cm, 1 case; DCIS, grade 1, 2 cases, grade 2, 3 cases and grade 3, 1 case). Fifty-two cases with clinico-radiological follow-up remained stable (24 to 148 months; median, 48 months). The overall upgrade rate was 9%.
Within the excision group, the only clinical, radiologic or histologic feature significantly associated with upgrade was nipple discharge (p=0.0075), but only 4 of 8 patients with upgrade had a nipple discharge. However, 33 patients with a mass ≥1cm in size included 6 of the 8 upgraded cases (75%).
Conclusions: The results of our study suggest that surgical excision of intraductal papilloma without atypia diagnosed on CNB should be considered for at least those patients who present with nipple discharge and/or a mass ≥1 cm.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 21, Monday Morning