title: The Role of Percutaneous Biopsy and Prognostic Factors of Malignancy in Solitary Breast Papilloma: A Retrospective Multicenter Study of 259 Cases.
abstract: OBJECTIVE
  Management of papillary breast lesions is a controversial issue, as complete excision implies surgery of numerous benign lesions. The purpose of this study was to assess concordance between percutaneous and surgical biopsy of papillomas along with factors predictive of malignancy.
  
  
  METHODS
  The study consisted of a retrospective review of papilloma cases between 2009 and 2013 at three breast cancer centers. All cases of papilloma histologically diagnosed by percutaneous biopsy and confirmed by surgical specimen were included. The biopsy results were compared with final surgical pathology. Lesion size and clinical and radiological features were recorded.
  
  
  RESULTS
  A total of 259 cases were included (188 simple and 71 complex papillomas). Concordance between histology after percutaneous and surgical biopsy was lower for complex papillomas, regardless of type, than for simple papillomas (p<0.001). The risk of having a complex papilloma was shown to be significantly higher in postmenopausal patients (p=0.023), and was 20 times higher if the percutaneous biopsy was malignant as opposed to benign (p<2.10). However, the false-negatives for percutaneous biopsy in complex papilloma cases were mainly related to atypical and in situ lesions.
  
  
  CONCLUSIONS
  Percutaneous biopsy does not appear adequate for identifying papillomas requiring surgical excision due to the risk of underestimation of cancerous lesions. However, certain factors predictive of malignancy may assist with surgical management, such as age and menopausal status, lesions peripheral to the nipple, and atypia on percutaneous biopsy.
authors.affiliation: Department of Gynecology, Anne de Bretagne University Hospital, Rennes, France.
authors.forename: Maude
authors.initials: M
authors.lastname: Laval
authors.affiliation: Department of Gynecology and Obstetrics, Bretonneau University Hospital, Tours, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Delangle
authors.affiliation: Department of Gynecology and Obstetrics, Poitiers University Hospital, Poitiers, France.
authors.forename: Aïcha
authors.initials: A
authors.lastname: Ndoye
authors.affiliation: Department of Clinical Pharmacology, Pontchaillou University Hospital, Rennes, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Sylvestre
authors.affiliation: Department of Clinical Pharmacology, Pontchaillou University Hospital, Rennes, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Laviolle
authors.affiliation: Department of Gynecology, Anne de Bretagne University Hospital, Rennes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lavoue
authors.affiliation: Department of Gynecology, Anne de Bretagne University Hospital, Rennes, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Levêque
mesh_terms: D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D010212:Papilloma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies
keywords: Papilloma of the breast; breast cancer; percutaneous biopsy; surgical biopsy