title: Papillomas of the breast: factors associated with underestimation.
abstract: The distinction between benign and malignant papilloma of the breast through percutaneous needle biopsy can be difficult because of limited samples; the underestimation rate can be up to 25%. The aim of this study is to identify clinical and histological factors associated with underestimation, invasive ductal carcinoma, or ductal in-situ carcinoma (DCIS) of the breast found in surgical specimens from papillary lesions. This may contribute toward selection of patients for a follow-up strategy without the need for surgical excision. From a database of 3563 patients, we identified 85 with intraductal papilloma between 2007 and 2013 who had undergone breast-imaging studies, percutaneous needle biopsy, and surgical resection of the lesion. Central papillomas normally present with a palpable mass, whereas peripheral papillomas generally do not have clinical manifestations (microcalcifications); both central and peripheral papillomas were related to atypical lesions, 13.5 and 15.4%, respectively. Among the 59 cases of central papillomas, there were four cases of underestimation, three DCIS and one invasive ductal carcinoma (6.8%). Among the 26 cases of peripheral papillomas, there was one case of DCIS (3.8%), with a total underestimation rate of 5.8%; all underestimated lesions measured more than 1 cm. The median size was 11 mm at mammography and 19 mm at ultrasound. Our data suggest that lesions less than 1 cm in size, without atypia and concordant imaging and clinical findings, may not require surgical resection.
authors.affiliation: Department of Gynecology and Obstetrics.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Boufelli
authors.affiliation: Department of Pathology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Giannotti
authors.affiliation: Department of Gynecology and Obstetrics.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Ruiz
authors.affiliation: Department of Radiology.
authors.forename: Nestor de
authors.initials: N
authors.lastname: Barros
authors.affiliation: Department of Radiology.
authors.forename: Luciano F
authors.initials: LF
authors.lastname: Chala
authors.affiliation: Department of Gynecology and Obstetrics.
authors.forename: Jonathan Y
authors.initials: JY
authors.lastname: Maesaka
authors.affiliation: Department of Gynecology and Obstetrics.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Goncalves
authors.affiliation: Department of Radiology.
authors.forename: Bárbara H
authors.initials: BH
authors.lastname: Bresciani
authors.affiliation: Department of Pathology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Paula
authors.initials: P
authors.lastname: Vianna
authors.affiliation: Department of Gynecology and Obstetrics.
authors.forename: José M
authors.initials: JM
authors.lastname: Soares
authors.affiliation: Department of Gynecology and Obstetrics.
authors.forename: Edmund C
authors.initials: EC
authors.lastname: Baracat
authors.affiliation: Department of Gynecology and Obstetrics.
authors.forename: José R
authors.initials: JR
authors.lastname: Filassi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016217:Ultrasonography, Mammary / Q000379:methods*