Surgical follow-up and clinical presentation of 142 breast papillary lesions diagnosed by ultrasound-guided core-needle biopsy

Background: The clinical management of breast intraductal papilloma (IDP) remains controversial. The objective of this study was to survey a large cohort of benign IDP diagnosed on core needle biopsy (CNB) and to evaluate their clinical presentation and potential risk of associated atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), ductal carcinoma in situ (DCIS) or invasive carcinoma as identified by follow-up surgical excision. Methods: We analyzed 345 IDP on CNB; 142 (41.2%) received a subsequent surgical excision while 203 (58.8%) cases did not. Specimens were categorized as IDP, IPD+ADH, IDP+ALH, and DCIS. In patients with surgical follow-up the upgrade to a lesion of greater clinical significance was analyzed according to race, clinical presentation and multiplicity of papillomas. Results: Of the 142 cases, 125 (93.9%) patients had a single IDP, while 17 cases were among 8 patients with multiple IDPs. Patients were predominantly asymptomatic with CNB obtained as follow-up to an abnormal mammogram. Among solitary benign IDP, nearly 25% were upgraded (p < 0.001): 14.0% to ADH and 10.5% to DCIS. For patients with IDP+ADH on initial CNB, 22.2% were upgraded to DCIS. Of the asymptomatic cases 11.4% were upgraded to DCIS, while none of the symptomatic patients showed such upgrade (p < 0.001). In patients with no surgical excision 17 (8.3%) continue to have an abnormal mammogram. Conclusions: We recommend routine mammogram and surgical excision of all IDPs identified on CNB because almost one-fourth (24.5%) of solitary IDP at CNB were upgraded to either ADH or DCIS and the majority of cases were asymptomatic.