title: Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up.
abstract: BACKGROUND
  Clinical management of papillary breast lesions (PBLs) remains controversial. The objective of this study was to identify pathologic and radiologic predictors of malignancy from a large cohort of PBLs diagnosed on core-needle biopsy (CNB).
  
  
  METHODS
  Retrospective review of the institutional pathology database identified all PBLs diagnosed from 2001 to 2009 and surgically excised within 6 months of diagnosis. PBLs were divided into intraductal papilloma (IDP) and IDP associated with atypical ductal or lobular hyperplasia (ADH/ALH). Surgical pathology of all lesions was reviewed and upgrade was defined as a change to a lesion of greater clinical significance, including ALH, ADH, lobular, or ductal carcinoma in situ (LCIS or DCIS), and invasive ducal carcinoma (IDC).
  
  
  RESULTS
  We identified 276 patients (mean age 56 years; range 23 to 88 years) with PBLs on CNB. Seventy-nine patients (28.6%) upgraded to a lesion of greater clinical significance. Of the 234 (84.7%) had IDP only, 42 (17.9%) upgraded to ADH, and 21 (8.9%) to DCIS or IDC. Of the 42 (15.3%) patients with associated ADH or ALH on CNB, 16 (38.0%) upgraded to DCIS or IDC. The majority of patients (n = 173, 62.6%) had no breast symptoms. All patients had an abnormal mammogram and/or ultrasound that prompted the CNB. Among all clinical and radiographic variables analyzed, older age alone was predictive of upgrade.
  
  
  CONCLUSIONS
  Frequent upgrade to a high-risk lesion or cancer is observed with IDPs diagnosed on CNB without adequate identifiable clinical and radiographic risk factors. Surgical excision should be performed for all IDPs to delineate subsequent clinical management.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA 30308, USA. mrizzo@emory.edu
authors.forename: Monica
authors.initials: M
authors.lastname: Rizzo
authors.forename: Jared
authors.initials: J
authors.lastname: Linebarger
authors.forename: Michael C
authors.initials: MC
authors.lastname: Lowe
authors.forename: Lin
authors.initials: L
authors.lastname: Pan
authors.forename: Sheryl G A
authors.initials: SG
authors.lastname: Gabram
authors.forename: Leonel
authors.initials: L
authors.lastname: Vasquez
authors.forename: Michael A
authors.initials: MA
authors.lastname: Cohen
authors.forename: Marina
authors.initials: M
authors.lastname: Mosunjac
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D008875:Middle Aged; D060787:Neoplasm Grading; D010212:Papilloma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies