Skip to main content

Advertisement

SpringerLink
Log in

The Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In Situ in Patients with Intraductal Papilloma without Atypia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 034)

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Available retrospective data suggest the upgrade rate for intraductal papilloma (IP) without atypia on core biopsy (CB) ranges from 0 to 12%, leading to variation in recommendations. We conducted a prospective multi-institutional trial (TBCRC 034) to determine the upgrade rate to invasive cancer (IC) or ductal carcinoma in situ (DCIS) at excision for asymptomatic IP without atypia on CB.

Methods

Prospectively identified patients with a CB diagnosis of IP who had consented to excision were included. Discordant cases, including BI-RADS > 4, and those with additional lesions requiring excision were excluded. The primary endpoint was upgrade to IC or DCIS by local pathology review with a predefined rule that an upgrade rate of ≤ 3% would not warrant routine excision. Sample size and confidence intervals were based on exact binomial calculations. Secondary endpoints included diagnostic concordance for IP between local and central pathology review and upgrade rates by central pathology review.

Results

The trial included116 patients (median age 56 years, range 24–82) and the most common imaging abnormality was a mass (n = 91, 78%). Per local review, 2 (1.7%) cases were upgraded to DCIS. In both of these cases central pathology review did not confirm DCIS on excision. Additionally, central pathology review confirmed IP without atypia in core biopsies of 85/116 cases (73%), and both locally upgraded cases were among them.

Conclusion

In this prospective study of 116 IPs without atypia on CB, the upgrade rate was 1.7% by local review, suggesting that routine excision is not indicated for IP without atypia on CB with concordant imaging findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bekes I, deGregorio A, deWaal A, et al. Review on current treatment options for lesions of uncertain malignant potential (B3 lesions) of the breast: Do B3 papillary lesions need to be removed in any case by open surgery? Arch Gynecol Obstet. 2019;300:481–4.

    Article  CAS  Google Scholar 

  2. Neal L, Sandhu NP, Hieken TJ, et al. Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy. Mayo Clin Proc. 2014;89:536–47.

    Article  Google Scholar 

  3. Vargas HI, Romero L, Chlebowski RT. Management of bloody nipple discharge. Curr Treat Options Oncol. 2002;3:157–61.

    Article  Google Scholar 

  4. Collins LC, Schnitt SJ. Papillary lesions of the breast: selected diagnostic and management issues. Histopathology. 2008;52:20–9.

    Article  CAS  Google Scholar 

  5. Lewis JT, Hartmann LC, Vierkant RA, et al. An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol. 2006;30:665–72.

    Article  Google Scholar 

  6. Ahn SK, Han W, Moon HG, et al. Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: scoring system for predicting malignancy. Eur J Surg Oncol. 2018;44:53–8.

    Article  Google Scholar 

  7. Mishima C, Kagara N, Ikeda JI, et al. Mutational analysis of AKT1 and PIK3CA in intraductal papillomas of the breast with special reference to cellular components. Am J Pathol. 2018;188:1106–12.

    Article  CAS  Google Scholar 

  8. Kader T, Elder K, Zethoven M, et al. The genetic architecture of breast papillary lesions as a predictor of progression to carcinoma. NPJ Breast Cancer. 2020;6:9.

    Article  CAS  Google Scholar 

  9. Wen X, Cheng W. Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol. 2013;20:94–101.

    Article  Google Scholar 

  10. Mercado CL, Hamele-Bena D, Oken SM, Singer CI, Cangiarella J. Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology. 2006;238:801–8.

    Article  Google Scholar 

  11. Rakha EA, Lee AH, Jenkins JA, Murphy AE, Hamilton LJ, Ellis IO. Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Int J Cancer. 2011;129:1417–24.

    Article  CAS  Google Scholar 

  12. Rizzo M, Linebarger J, Lowe MC, et al. Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up. J Am Coll Surg. 2012;214:280–7.

    Article  Google Scholar 

  13. Nayak A, Carkaci S, Gilcrease MZ, et al. Benign papillomas without atypia diagnosed on core needle biopsy: experience from a single institution and proposed criteria for excision. Clin Breast Cancer. 2013;13:439–49.

    Article  Google Scholar 

  14. Weisman PS, Sutton BJ, Siziopikou KP, et al. Non-mass-associated intraductal papillomas: is excision necessary? Hum Pathol. 2014;45:583–8.

    Article  Google Scholar 

  15. Nakhlis F, Ahmadiyeh N, Lester S, Raza S, Lotfi P, Golshan M. Papilloma on core biopsy: excision vs. observation. Ann Surg Oncol. 2015;22:1479–82.

    Article  Google Scholar 

  16. Hong YR, Song BJ, Jung SS, Kang BJ, Kim SH, Chae BJ. Predictive factors for upgrading patients with benign breast papillary lesions using a core needle biopsy. J Breast Cancer. 2016;19:410–6.

    Article  Google Scholar 

  17. Pareja F, Corben AD, Brennan SB, et al. Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies: rate of upgrade to carcinoma at excision. Cancer. 2016;122:2819–27.

    Article  Google Scholar 

  18. Armes JE, Galbraith C, Gray J, Taylor K. The outcome of papillary lesions of the breast diagnosed by standard core needle biopsy within a BreastScreen Australia service. Pathology. 2017;49:267–70.

    Article  Google Scholar 

  19. Khan S, Diaz A, Archer KJ, et al. Papillary lesions of the breast: To excise or observe? Breast J. 2018;24:350–5.

    Article  Google Scholar 

  20. Ko D, Kang E, Park SY, et al. The management strategy of benign solitary intraductal papilloma on breast core biopsy. Clin Breast Cancer. 2017;17:367–72.

    Article  Google Scholar 

  21. Han SH, Kim M, Chung YR, et al. Benign intraductal papilloma without atypia on core needle biopsy has a low rate of upgrading to malignancy after excision. J Breast Cancer. 2018;21:80–6.

    Article  Google Scholar 

  22. Asirvatham JR, Jorns JM, Zhao L, Jeffries DO, Wu AJ. Outcomes of benign intraductal papillomas diagnosed on core biopsy: a review of 104 cases with subsequent excision from a single institution. Virchows Arch. 2018;473:679–86.

    Article  Google Scholar 

  23. Liu C, Sidhu R, Ostry A, et al. Risk of malignancy in papillary neoplasms of the breast. Breast Cancer Res Treat. 2019;178:87–4.

    Article  CAS  Google Scholar 

  24. Genco IS, Tugertimur B, Manolas PA, Hasanovic A, Hajiyeva S. Upgrade rate of intraductal papilloma without atypia on breast core needle biopsy: a clinical, radiological and pathological correlation study. Am J Surg. 2020. https://doi.org/10.1016/j.amjsurg.2020.01.040.

    Article  PubMed  Google Scholar 

  25. Mercado CL. BI-RADS update. Radiol Clin North Am. 2014;52:481–7.

    Article  Google Scholar 

  26. Nakhlis F, Gilmore L, Gelman R, et al. Incidence of adjacent synchronous invasive carcinoma and/or ductal carcinoma In-situ in patients with lobular neoplasia on core biopsy: results from a prospective multi-institutional registry (TBCRC 020). Ann Surg Oncol. 2016;23:722–8.

    Article  Google Scholar 

  27. Coughlin, SS. Epidemiology of Breast Cancer in Women. In: Ahmad A. (eds) Breast Cancer Metastasis and Drug Resistance. Advances in Experimental Medicine and Biology. vol 1152. Springer, 2019:9–29.

  28. Kim WG, Cummings MC, Lakhani SR. Pitfalls and controversies in pathology impacting breast cancer management. Expert Rev Anticancer Ther. 2020;20:205–19.

    Article  CAS  Google Scholar 

  29. Tatarian T, Sokas C, Rufail M, et al. Intraductal papilloma with benign pathology on breast core biopsy: to excise or not? Ann Surg Oncol. 2016;23:2501–7.

    Article  Google Scholar 

  30. Sohn V, Keylock J, Arthurs Z, et al. Breast papillomas in the era of percutaneous needle biopsy. Ann Surg Oncol. 2007;14:2979–84.

    Article  Google Scholar 

  31. Swapp RE, Glazebrook KN, Jones KN, et al. Management of benign intraductal solitary papilloma diagnosed on core needle biopsy. Ann Surg Oncol. 2013;20:1900–5.

    Article  Google Scholar 

Download references

Acknowledgments

We are grateful for the funding support to the TBCRC from The Breast Cancer Research Foundation and Susan G. Komen. This study was chosen as an oral presentation at the Society of Surgical Oncology 2020 International Conference on Surgical Cancer Care, Boston, MA, initially scheduled for March 25–28, 2020, rescheduled to August 17–19, 2020. The authors have no conflict of interest disclosures to report, and the findings presented in this manuscript have not been published elsewhere.

Funding

The Breast Cancer Research Foundation and Susan G. Komen.

Author information

Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Faina Nakhlis MD, Katherina Z. Calvillo MD & Tari A. King MD

  2. Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Faina Nakhlis MD, Katherina Z. Calvillo MD, Paulina Lange BS, Stephen D. DeSantis BS, Stuart J. Schnitt MD & Tari A. King MD

  3. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Gabrielle M. Baker MD

  4. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Melissa Pilewskie MD

  5. Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA

    Rebecca Gelman PhD

  6. Indiana University Cancer Center, Indianapolis, IN, USA

    Kandice Ludwig MD

  7. UPMC Hillman Cancer Center, Pittsburgh, PA, USA

    Priscilla F. McAuliffe MD, PhD

  8. Georgetown University Cancer Center, Washington, DC, USA

    Shawna Willey MD

  9. Duke University Medical Center, Durham, NC, USA

    Laura H. Rosenberger MD

  10. University of Alabama, Birmingham, AL, USA

    Catherine Parker MD

  11. University of North Carolina, Chapel Hill, NC, USA

    Kristalyn Gallagher DO

  12. Johns Hopkins University, Baltimore, MD, USA

    Lisa Jacobs MD

  13. Montefiore Medical Center, New York, NY, USA

    Sheldon Feldman MD

Authors
  1. Faina Nakhlis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabrielle M. Baker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melissa Pilewskie MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rebecca Gelman PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katherina Z. Calvillo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kandice Ludwig MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Priscilla F. McAuliffe MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shawna Willey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Laura H. Rosenberger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Catherine Parker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kristalyn Gallagher DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Lisa Jacobs MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Sheldon Feldman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Paulina Lange BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Stephen D. DeSantis BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Stuart J. Schnitt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Tari A. King MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Faina Nakhlis MD.

Ethics declarations

Disclosures

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 24 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakhlis, F., Baker, G.M., Pilewskie, M. et al. The Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In Situ in Patients with Intraductal Papilloma without Atypia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 034). Ann Surg Oncol 28, 2573–2578 (2021). https://doi.org/10.1245/s10434-020-09215-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-09215-w

Search

Navigation