[195] Surgical Excision May Not Be Necessary for Benign Papillomas on Core Biopsy: A Large Retrospective Study in an Academic Women Center

Xin Li, Mohamed Desouki, David Dabbs, Susan Shyu, Glory Carter, Lu Wang, Chengquan Zhao. Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA

Background: The clinical management of benign papillomas detected by needle core biopsy (NCB) remains controversial. There is great discrepancy of reported upstaging rate at excision, ranging from 0% to 25%.
Design: A computer based search was carried out on our database from January 2005 to December 2010, to identify the cases of papilloma and atypical papilloma diagnosed on NCB. The pathological findings in follow up excision (FUE), BI-RADS scores and time between biopsy and FUE were recorded and analyzed.
Results: Total 18361 cases of NCB were performed during the study period. 648 (3.5%) cases were interpreted as papilloma (IP) (n=576) or atypical papilloma (AP) (n=72). 106 cases were excluded due to prior history of or synchronous malignant breast lesions or ADH/ALH. Of the 542 cases of IP (482) or AP (60), 422 (78.0%) had FUE, including 369 cases of IP and 53 cases of AP. The mean interval between NCB and FUE was 2.0 months (0.2-15.5) for IP and 1.6 months (0.5-5.5) for AP. The BI-RADS scores for IP were: 1-3 in 14/323 (4.3%), 4 in 303/323 (93.8%), 5 in 6/323 (1.8%) of cases; for AP were: 2 in 2/43 (4.7%), 4 in 40/43 (93%, and 5 in 1/43 (2.3%) of cases. The discovery of significant lesions upon surgical excision of papilloma is shown in the [table 1]. The BI-RADS score was 4 for all 5 cases of DCIS and polymorphic LCIS in IP group. Score 5 in one case, which was papillary carcinoma and score 4 in 5/6 cases of DCIS and IC in AP group.

Table 1: Findings on Subsequent Breast Excision
 IP N=369AP N=53Total N=422
Invasive Carcinoma0 (0%)2 (3.8%)2 (0.5%)
DCIS5* (1.4%)4 (7.6%)9 (2.1%)
ADH48** (13%)19 (35.9%)67 (15.9%)
LN7 (1.9%)0 (0%)7 (1.7%)
ADH/LN6 (1.6%)1 (1.9%)7 (1.7%)
Total66 (17.9%)26 (49%)92 (21.8%)
* includes one polymorphic LCIS; ** includes 8 atypical papilloma; LN includes ALH and LCIS


Conclusions: Of 369 patients with diagnosis of benign papillomas on CNB, 5 (1.4%) cases were upstaged to DCIS or pleomorphic LCIS on FUE compared with 11.4% of DCIS or IC in AP group (p<0.01).
Our results suggest that FUE may not be required for benign papilloma diagnosed on CNB in patients without any associated other risk factors while FUE is recommended for all AP cases.
Category: Breast

Tuesday, March 20, 2012 9:30 AM

Poster Session III # 14, Tuesday Morning

 

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