A Follow-Up Study of 283 Patients Diagnosed with Papillary Lesions of the Breast.
Haitham Arabi, Sudeshna Bandyopadhyay, Bassam Albashiti, Haider Skeirek, Sumit Yadam, Yaser Hussein, Amro Almradi, Rouba Ali-Fehmi. Wayne State Univ, Detroi, MI
Background: There is abundant evidence that atypical papillary lesions of the breast are associated with a significant risk of carcinoma. The clinical significance of diagnosing a "benign" papilloma in breast biopsy specimens is controversial. The objective of this study was to evaluate the risk associated with benign and atypical papillomas in limited 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 categorized as benign papillomas and atypical papillomas (papillomas with atypical architectural/cytological features or papilloma with coexistent atypical ductal hyperplasia). All papillomas with coexistent DCIS or invasive carcinoma were excluded. Statistical correlation of these categories with patient follow up was determined using Chi-square test.
Results: 283 of 415 papillary lesions (68%) had subsequent histologic f/u. The mean age at diagnosis for all patients was 52 years (19-93 y). The median f/u was 106 months. 250 cases out of 283 were classified as benign papilloma with no atypia and 33 as atypical papilloma. In patients who were initially diagnosed with atypical papilloma, significant disease (in-situ, papillary and /or invasive carcinoma) was identified on the f/u excision in 3 (9%) of 33 (1 LCIS, 1 papillary ca, 1 poorly differentiated invasive Ca). In patients who were initially diagnosed with benign papilloma, significant disease was identified on the f/u excision in 4 (1.6 %) of 250 (1 Low grade DCIS, 1 Papillary Ca, 2 invasive poorly differentiated Ca), (p=0.04).The mean age at diagnosis of patients with significant disease was 50.4 years (33-80 y). The median interval between the initial biopsy and diagnosis of significant disease was 52 months (1- 119 m). The mean size of papilloma at the time of initial diagnosis and subsequent histologic sampling was 9 mm and 12mm, respectively. Persistent papillomas were found in all follow up excisions.
|Follow-up diagnosis||P value|
|Initial diagnosis||Benign||In-situ, papillary or Invasive Carcinoma||0.04|
|Benign Papilloma (N=250)||246 (98.4%)||4 (1.6%)|
|Atypical Papilloma (N=33)||30 (91%)||3 (9%)|