Rates of upgrade to malignancy in surgical excision of intraductal papillomas of the breast: A retrospective cohort study

Abstract

Background/Aim: Intraductal papillomas (IDP) of the breast, though benign, share an association with the duct epithelium, similar to some breast malignancies. Percutaneous biopsies often fail to fully characterize these lesions. The decision to perform surgical excision for IDP of the breast is frequently based on the presence of atypia observed during percutaneous biopsy. However, consensus remains lacking regarding the management of IDP of the breast without atypia. This study was undertaken to share findings on IDP, contributing to a better understanding of their nature and guiding treatment approaches. Methods: We conducted a retrospective evaluation of data from 42 female patients diagnosed with intraductal papilloma through percutaneous biopsy, who subsequently underwent surgical excision between January 1, 2015, and August 25, 2023. Patients not diagnosed with intraductal papilloma, those with prior breast malignancy diagnoses, and those identified incidentally during other surgical procedures were excluded from the study. Data recorded included patient ages, the largest lesion diameters measured by ultrasonography, the percutaneous biopsy method (Fine needle aspiration biopsy [FNAB] or Core needle biopsy [CNB]), atypia status observed during percutaneous biopsy, histopathological features observed during surgical excision, and lesion diameter in cases where malignancy was upgraded. If ductal carcinoma in situ (DCIS) or invasive cancer was identified in the surgical excision specimen, it was classified as an upgrade. Results: The median age of the patients was 48.5 years (range: 12.9 years). FNAB was performed in ten cases (23.8%), while CNB was used in 32 cases (76.2%). There was no significant difference in the detection of atypia when comparing FNAB and CNB (P=0.57). Eight patients (19%) were diagnosed with atypical intraductal papilloma. Among them, three patients with atypia and two patients without atypia exhibited an upgrade to malignancy. The study revealed a malignancy upgrade rate of 37.5% for IDP with atypia and 5.9% for those without atypia. Furthermore, the average age of patients with malignancy upgrades was higher than that of patients with benign lesions (P=0.02). Conclusion: In light of the malignancies detected in cases of breast IDP, even in the absence of atypia, opting for surgical excision, particularly in older patients, can help prevent the oversight of these cancers.