S. Martin1, J. Richman2, C. Parker2, R. Lancaster2 1University of North Carolina at Charlotte,Charlotte, NC, USA 2University of Alabama at Birmingham,Department Of Surgery,Birmingham, AL, USA
Introduction: Breast intraductal papillomas (IP) are epithelial fibrovascular stalks occurring within the ducts of the breast. IPs may be symptomatic or asymptomatic and have a variable presentation with many detected by routine breast screening. Controversy exists regarding the need for surgical excision of these lesions with differing rates of upgrade reported (2.2-15.7%) at excision. IPs with atypia or pathologic discharge are typically surgically removed due to increased concern for upgrade. In this retrospective single institution study, we quantified the upgrade rates of IPs at surgical excision. Additionally, we sought to identify factors associated with increased risk of upgrade of IPs to precancerous or invasive malignancy at surgical.
Methods: We retrospectively reviewed data from women who had received a core needle biopsy diagnosis of intraductal papilloma between 2010 and 2016 at a single institution. Any women who had concurrent diagnosis of contralateral or ipsilateral breast cancer were excluded. Data regarding imaging characteristics and patient factors were collected.
Results: The study included 195 cases of intraductal papilloma diagnosed by biopsy (mean age 55.6, range 28-99); 22 biopsies (16.1%) had atypia and 19 (13.9%) had bloody nipple discharge. 137 of the women (70.3%) underwent surgical excision. Among the women who underwent surgical excision, 4 (2.9%) were upgraded to ductal carcinoma in situ. No upgrade to invasive cancer was identified. Of the 58 women who did not undergo excision, 1 (1.7 %) developed a subsequent invasive malignancy. Overall, 4 women (2.1 %) developed DCIS or an invasive carcinoma within the years (1.5-4 years) post-IP diagnosis.
Conclusion: This study reveals a low upgrade rate for IPs suggesting that surgical excision may not be necessary in the majority of cases. Additional studies to include larger patient numbers focusing on specific risk factors associated with upgrade would be beneficial.