title: Intraductal papillomas on core biopsy can be upgraded to malignancy on subsequent excisional biopsy regardless of the presence of atypical features.
abstract: Intraductal papillary lesions of the breast constitute a heterogeneous entity, including benign intraductal papilloma (IDP) with or without atypia and malignant papillary carcinoma. Differentiating between these diagnoses can be challenging. We re-evaluated core biopsy specimens that were diagnosed as IDP and the corresponding surgical excision specimens, and assessed the potential risk for the diagnosis to be modified to malignancy based on excision. By sorting the pathology database of the National Cancer Center Hospital, Tokyo, we identified 146 core biopsy cases that were histologically diagnosed as IDP between 1997 and 2013. The re-evaluated diagnosis was IDP without atypia in 79 (54%) patients, IDP with atypia in 66 (45%), and ductal carcinoma in situ (DCIS) in 1 (1%). Among the 34 patients (23%) who underwent surgical excision subsequent to core biopsy, histological diagnosis was upgraded to carcinoma, excluding lobular carcinoma in situ (LCIS), in 14 (41%) cases, including 4 (33%) of 12 IDPs without atypia and 10 (45%) of 22 IDPs with atypia. Complete surgical excision should be kept in mind for all IDPs diagnosed on core biopsy, not only IDPs with atypia but IDPs without atypia, especially when clinical or imaging diagnosis findings cannot rule out the possibility of malignancy, because papillary lesions comprise a variety of morphological appearances.
authors: Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Sho
authors: S
authors: Shiino
authors: Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan.|Department of Basic Pathology, National Defense Medical College, Tokorozawa, Japan.
authors: Hitoshi
authors: H
authors: Tsuda
authors: Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan.
authors: Masayuki
authors: M
authors: Yoshida
authors: Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Kenjiro
authors: K
authors: Jimbo
authors: Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Sota
authors: S
authors: Asaga
authors: Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Takashi
authors: T
authors: Hojo
authors: Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Takayuki
authors: T
authors: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000145:classification / Q000473:pathology*; D002278:Carcinoma in Situ / Q000145:classification / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000145:classification / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000145:classification / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000145:classification / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D018300:Papilloma, Intraductal / Q000145:classification / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: World Health Organization (WHO) classification; breast cancer; core needle biopsy; intraductal papilloma; surgical excision; upgrade