title: An International Multicenter Review of the Malignancy Rate of Excised Papillomatous Breast Lesions.
abstract: BACKGROUND
  Papillary lesions of the breast are a relatively rare, but heterogeneous group ranging from benign to atypical and malignant. Debate exists regarding the optimal management of these lesions. In the absence of more accurate risk-stratification models, traditional management guidelines recommend surgical excision, despite the majority of lesions proving benign. This study sought to determine the rate of malignancy in excised breast papillomas and to elucidate whether there exists a population in which surgical excision may be unnecessary.
  
  
  METHODS
  A multicenter international retrospective review of core biopsy diagnosed breast papillomas and papillary lesions was performed between 2009 and 2013, following institutional ethical approval. Patient demographics, histopathological, and radiological findings were recorded. All data was tabulated, and statistical analysis performed using Stata.
  
  
  RESULTS
  A total of 238 patients were included in the final analysis. The age profile of those with benign pathology was significantly younger than those with malignant pathology (p < 0.001). Atypia on core needle biopsy was significantly associated with a final pathological diagnosis of malignancy (OR = 2.73). The upgrade rate from benign core needle biopsy to malignancy on the final pathological sample was 14.4 %; however, only 3.7 % had invasive cancer.
  
  
  CONCLUSIONS
  This international dataset is one of the largest in the published literature relating to breast papillomas. The overall risk of malignancy is significantly associated with older age and the presence of atypia on core needle biopsy. It may be possible to stratify higher-risk patients according to age and core needle biopsy findings, thereby avoiding surgery on low-risk patients.
authors.affiliation: Breast Research Centre, Cork University Hospital, Cork, Ireland. foleynm@tcd.ie.
authors.forename: N M
authors.initials: NM
authors.lastname: Foley
authors.affiliation: Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: Racz
authors.affiliation: Department of Surgery, Beaumont Hospital, Dublin, Ireland.|The Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Z
authors.initials: Z
authors.lastname: Al-Hilli
authors.affiliation: Breast Research Centre, Cork University Hospital, Cork, Ireland.
authors.forename: V
authors.initials: V
authors.lastname: Livingstone
authors.affiliation: Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Cil
authors.affiliation: Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada.
authors.forename: C M B
authors.initials: CM
authors.lastname: Holloway
authors.affiliation: Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK.
authors.forename: L
authors.initials: L
authors.lastname: Romics
authors.affiliation: Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary.
authors.forename: Z
authors.initials: Z
authors.lastname: Matrai
authors.affiliation: Breast Research Centre, Cork University Hospital, Cork, Ireland.
authors.forename: M W
authors.initials: MW
authors.lastname: Bennett
authors.affiliation: Breast Research Centre, Cork University Hospital, Cork, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Duddy
authors.affiliation: Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Nofech-Mozes
authors.affiliation: Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Slodkowska
authors.affiliation: Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK.
authors.forename: E A
authors.initials: EA
authors.lastname: Mallon
authors.affiliation: Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK.
authors.forename: N
authors.initials: N
authors.lastname: Dawson
authors.affiliation: Department of Surgery, Beaumont Hospital, Dublin, Ireland.|The Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: T
authors.initials: T
authors.lastname: Roche
authors.affiliation: Breast Research Centre, Cork University Hospital, Cork, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Relihan
authors.affiliation: Department of Surgery, Beaumont Hospital, Dublin, Ireland.|The Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: A D K
authors.initials: AD
authors.lastname: Hill
authors.affiliation: Breast Research Centre, Cork University Hospital, Cork, Ireland.
authors.forename: H P
authors.initials: HP
authors.lastname: Redmond
authors.affiliation: Breast Research Centre, Cork University Hospital, Cork, Ireland.
authors.forename: M A
authors.initials: MA
authors.lastname: Corrigan
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007390:International Agencies; D008875:Middle Aged; D009367:Neoplasm Staging; D010212:Papilloma / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies