Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies: Rate of upgrade to carcinoma at excision.
The surgical management of mammary intraductal papilloma without atypia (IDP) identified at core-needle biopsy (CNB) is controversial. This study assessed the rate of upgrade to carcinoma at surgical excision (EXC).



This study identified women with a CNB diagnosis of intraductal papilloma without atypia or carcinoma at a cancer center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. The radiologic and clinicopathologic features of patients with a CNB diagnosis of IDP were correlated with an upgrade to carcinoma at EXC.



The study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent EXC. The upgrade rate was 2.3% (4 of 171). The upgraded lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥ 8 mm away. Twenty-four women (25 IDPs) did not undergo EXC and had stable imaging on follow-up (median, 23.5 months).



The upgrade rate at EXC for IDPs diagnosed at CNB with radiologic-pathologic concordance was 2.3%. These findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2819-2827. © 2016 American Cancer Society.
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
Fresia
F
Pareja
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
Adriana D
AD
Corben
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
Sandra B
SB
Brennan
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
Melissa P
MP
Murray
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
Zenica L
ZL
Bowser
Department of Pathology, St. Michael's Hospital, Toronto, Ontario, Canada.
Kiran
K
Jakate
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
Christopher
C
Sebastiano
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Monica
M
Morrow
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
Elizabeth A
EA
Morris
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
Edi
E
Brogi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000379:methods; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D018300:Papilloma, Intraductal / Q000473:pathology* / Q000601:surgery
atypia; biopsy; breast; carcinoma; core needle; excision; papilloma; upgrade