Vol 90, No 2 (2019)
Review paper
Published online: 2019-02-28

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Intraductal papilloma of the breast — management

Diana Hodorowicz-Zaniewska12, Joanna Szpor23, Pawel Basta24
Pubmed: 30860277
Ginekol Pol 2019;90(2):100-103.

Abstract

In light of the growing availability of ultrasound testing and invasive diagnostic methods of the breast in everyday gyneco- logic practice, lesions of uncertain malignant potential, classified histologically as B3, have become a significant health issue. Intraductal papillomas (IPs) are the most common pathology in that group of lesions. Despite their benign histologic appearance, IPs may accompany malignant growths and the diagnosis made on the basis of biopsy material carries the risk of breast cancer (BC) underestimation. The article presents a review of the available literature on the management of patients diagnosed with intraductal papilloma at a standard core needle biopsy or vacuum-assisted core needle biopsy. The management is not uniform and depends not only on the verification technique or the accompanying pathological growths, but also on the result of clinical-pathological correlations. As it turns out, open surgical biopsy should not necessarily be recommended to every affected woman, and a growing number of sources have recently suggested that a control program would be sufficient in many cases. Thus, it is vital for gynecologists to be able to differentiate between those women who may be included in the annual ultrasound control program and those who require further surgical management. 

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References

  1. Ellis IO, Humphreys S, Michell M, et al. UK National Coordinating Commmittee for Breast Screening Pathology, European Commission Working Group on Breast Screening Pathology. Best Practice No 179. Guidelines for breast needle core biopsy handling and reporting in breast screening assessment. J Clin Pathol. 2004; 57(9): 897–902.
  2. Dennis MA, Parker S, Kaske TI, et al. Incidental treatment of nipple discharge caused by benign intraductal papilloma through diagnostic Mammotome biopsy. AJR Am J Roentgenol. 2000; 174(5): 1263–1268.
  3. Boufelli G, Giannotti MA, Ruiz CA, et al. Papillomas of the breast: factors associated with underestimation. Eur J Cancer Prev. 2018; 27(4): 310–314.
  4. Paterok EM, Rosenthal H, Säbel M. Nipple discharge and abnormal galactogram. Results of a long-term study (1964-1990). Eur J Obstet Gynecol Reprod Biol. 1993; 50(3): 227–234.
  5. Ganesan S, Karthik G, Joshi M, et al. Ultrasound spectrum in intraductal papillary neoplasms of breast. Br J Radiol. 2006; 79(946): 843–849.
  6. Al Sarakbi W, Worku D, Escobar PF, et al. Breast papillomas: current management with a focus on a new diagnostic and therapeutic modality. Int Semin Surg Oncol. 2006; 3(1): 1–8.
  7. Jacobs TW, Connolly JL, Schnitt SJ. Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? Am J Surg Pathol. 2002; 26(9): 1095–1110.
  8. Maxwell AJ. Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience. Clin Radiol. 2009; 64(8): 801–806.
  9. Bonaventure T, Cormier B, Lebas P, et al. [Benign papilloma: is US-guided vacuum-assisted breast biopsy an alternative to surgical biopsy?]. J Radiol. 2007; 88(9 Pt 1): 1165–1168.
  10. Haagensen CD, Bodain C, Haagensen DE. Breast carcinoma risk and detection. WB Saunders, Philadelphia 1981: 146.
  11. Brookes MJ, Bourke AG. Radiological appearances of papillary breast lesions. Clin Radiol. 2008; 63(11): 1265–1273.
  12. Athanasiou A, Aubert E, Vincent Salomon A, et al. Complex cystic breast masses in ultrasound examination. Diagn Interv Imaging. 2014; 95(2): 169–179.
  13. Hoda S, Kaplan R. World Health Organization (WHO) Classification of Breast Tumours, 4th ed. The American Journal of Surgical Pathology. 2013; 37(2): 309–310.
  14. Agoumi M, Giambattista J, Hayes MM. Practical Considerations in Breast Papillary Lesions: A Review of the Literature. Arch Pathol Lab Med. 2016; 140(8): 770–790.
  15. Nakano S, Sakamoto H, Ohtsuka M, et al. Evaluation and indications of ultrasound-guided vacuum-assisted core needle breast biopsy. Breast Cancer. 2007; 14(3): 292–296.
  16. 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(18): 2819–2827.
  17. Leithner D, Kaltenbach B, Hödl P, et al. Intraductal Papilloma Without Atypia on Image- Guided Breast Biopsy: Upgrade Rates to Carcinoma at Surgical Excision. Breast Care (Basel). 2018; 13(5): 364–368.
  18. Kiran S, Jeong YJu, Nelson ME, et al. Are we overtreating intraductal papillomas? J Surg Res. 2018; 231: 387–394.
  19. Khan S, Diaz A, Archer KJ, et al. Papillary lesions of the breast: To excise or observe? Breast J. 2018; 24(3): 350–355.
  20. Shiino S, Tsuda H, Yoshida M, et al. Intraductal papillomas on core biopsy can be upgraded to malignancy on subsequent excisional biopsy regardless of the presence of atypical features. Pathol Int. 2015; 65(6): 293–300.
  21. Am Soc Breast Surg: Consensus guideline on concordance assessment of image-guided breast biopsies and management of borderline or high-risk lesions. Nov 2, 2016. https://www.breastsurgeons.org/new_layout/about/statements/PDF_Statements/Concordance_and_High%20RiskLesions.pdf.
  22. Rageth CJ, O'Flynn EAm, Comstock C, et al. First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 2016; 159(2): 203–213.
  23. Mosier AD, Keylock J, Smith DV. Benign papillomas diagnosed on large-gauge vacuum-assisted core needle biopsy which span <1.5 cm do not need surgical excision. Breast J. 2013; 19(6): 611–617.
  24. Chang JM, Han W, Moon WK, et al. Papillary lesions initially diagnosed at ultrasound-guided vacuum-assisted breast biopsy: rate of malignancy based on subsequent surgical excision. Ann Surg Oncol. 2011; 18(9): 2506–2514.
  25. Saladin C, Haueisen H, Kampmann G, et al. MIBB Group. Lesions with unclear malignant potential (B3) after minimally invasive breast biopsy: evaluation of vacuum biopsies performed in Switzerland and recommended further management. Acta Radiol. 2016; 57(7): 815–821.