title: Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy.
abstract: OBJECTIVE
  Intraductal papilloma (IDP) is a benign breast disease with malignant potential, for which complete surgical excision is usually recommended. The aim of the present study was to investigate predictive factors for upgrading patients with a benign papillary lesion (BPL).
  
  
  METHODS
  This study was an observational study using a prospectively collected cohort. In total, 13,049 patients who underwent a core needle biopsy (CNB) for a breast lesion between January 2009 and May 2015 were enrolled. We reviewed all patients with pathologically confirmed BPL from a CNB.
  
  
  RESULTS
  Surgical treatment was performed for 363 out of a total of 592 lesions. According to the pathological differences, the lowest upgrade rate was shown in IDP without atypia (without atypia, 6.0%; with atypia, 26.8%; papillary neoplasm, 31.5%;p<0.001). The univariate analysis showed that, in IDP without atypia, the age at diagnosis, size of BPL on ultrasonography, and density on mammography were associated with upgrading. The multivariate analysis revealed that age >54 years and lesion size >1 cm were significantly associated with upgrade to malignancy (odds ratio [OR]=4.351,p=0.005 and OR=4.236,p=0.001, respectively).
  
  
  CONCLUSIONS
  The indications for surgical treatment can be defined as age >54 years and mass size >1 cm, even in IDP without atypia in the CNB results; this also includes cases of IDP with atypia or papillary neoplasm. Therefore, we suggest that close observation without surgery is sufficient for younger women with a small IDP without atypia.
authors.affiliation: Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Young Ran
authors.initials: YR
authors.lastname: Hong
authors.affiliation: Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Song
authors.affiliation: Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Sang Seol
authors.initials: SS
authors.lastname: Jung
authors.affiliation: Department of Radiology, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Bong Joo
authors.initials: BJ
authors.lastname: Kang
authors.affiliation: Department of Radiology, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Sung Hun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.; Cancer Research Institute, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Chae
keywords: Atypia; Biopsy; Breast neoplasms; Intraductal papilloma; Large core needle