Follow-Up Analysis of Benign Papillomas Diagnosed on Breast Core Needle Biopsy
Ryan E Swapp, Hannah M Brands, Katie N Jones, Katrina N Glazebrook, Tina J Hieken, Daniel W Visscher, Carol Reynolds. Mayo Clinic, Rochester, MN
Background: The aim of this study is to determine whether core biopsy (CB) proven benign papilloma with concordant imaging needs to be surgically excised.
Design: A text search of our institution's database for papillary lesions diagnosed by CB was performed between January 2003 and June 2010. Two pathologists evaluated all histologic materials without knowledge of the original diagnosis or patient outcome. The papillary lesions were designated as benign, atypical, or malignant. Any discrepant case between the initial diagnosis and second review was reviewed by a third “tiebreaker” pathologist. Three radiologists reviewed all cases for concordance. Details regarding pathologic results and follow-up imaging were recorded.
Results: Two hundred sixty papillary lesions diagnosed on CB with concordant imaging were identified. Of these, 207 (80%) were classified as benign, 40 (15%) atypical, and 13 (5%) malignant. Fifteen (7%) benign papillomas were excluded due to an associated high risk lesion adjacent to the papilloma or concurrent malignancy in the same quadrant of the breast. Fifty-four (26%) women underwent immediate excision. Surgical excision resulted in 47 (87%) benign papillomas, 1 (2%) atypical papilloma, and 4 (7%) with no residual papilloma. Two (4%) women underwent mastectomy for an invasive carcinoma in a different quadrant of the same breast and the papilloma biopsy site was not sampled. Fourteen (10%) women underwent delayed excision (8.7 to 74.4 mo., mean 26.1 mo.), 12 of which were at the prior CB site. Ten (83%) showed benign papilloma and 2 (17%) were atypical. Of the remaining 124 benign papillomas on CB, 83 were stable at last follow-up (13.6 to 93.8 mo., mean 35.8 mo.) and 41 women were lost to follow-up. Overall, in the immediate and delayed excisions, only 3 (4.5%) cases were upgraded to atypia with no malignant upgrades.
Conclusions: The likelihood of finding undetected atypia or malignancy in excision of a CB proven benign papilloma is extremely low when imaging is concordant. In our cohort, only 4.5 % of benign papillomas diagnosed on CB were upgraded to atypia. These data support clinical follow up, rather than mandated surgical excision, for patients diagnosed with a benign papilloma on CB when imaging findings are concordant and in the absence of associated high-risk lesion or concurrent malignancy.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 29, Monday Morning