Are we overtreating papillomas diagnosed on core needle biopsy?
BACKGROUND
Breast papillomas often are diagnosed with core needle biopsy (CNB). Most studies support excision for atypical papillomas, because as many as one half will be upgraded to malignancy on final pathology. The literature is less clear on the management of papillomas without atypia on CNB. Our goal was to determine factors associated with pathology upgrade on excision.


METHODS
Our pathology database was searched for breast papillomas diagnosed by CNB during the past 10 years. We identified 277 charts and excluded lesions associated with atypia or malignancy on CNB. Two groups were identified: papillomas that were surgically excised (group 1) and those that were not (group 2). Charts were reviewed for the subsequent diagnosis of cancer or high-risk lesions. Appropriate statistical tests were used to analyze the data.


RESULTS
A total of 193 papillomas were identified. Eighty-two lesions were excised (42%). Caucasian women were more likely to undergo excision (p = 0.03). Twelve percent of excised lesions were upgraded to malignancy. Increasing age was a predictor of upgrading, but this was not significant. Clinical presentation, lesion location, biopsy technique, and breast cancer history were not associated with pathology upgrade. Two lesions in group 2 ultimately required excision due to enlargement, and both were upgraded to malignancy.


CONCLUSIONS
Twenty-four percent of papillomas diagnosed on CNB have upgraded pathology on excision--half to malignancy. All of the cancers diagnosed were stage 0 or I. For patients in whom excision was not performed, 2 of 111 papillomas were later excised and upgraded to malignancy.
Department of Surgery, Washington University School of Medicine, Campus Box 8109, 660 South Euclid Avenue, Saint Louis, MO, USA. cyra@wudosis.wustl.edu
Amy E
AE
Cyr
Deborah
D
Novack
Kathryn
K
Trinkaus
Julie A
JA
Margenthaler
William E
WE
Gillanders
Timothy J
TJ
Eberlein
Jon
J
Ritter
Rebecca L
RL
Aft
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010212:Papilloma / Q000175:diagnosis* / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies