Factors associated with histologic upgrade following surgical excision of breast papillomas: a retrospective multicenter study.

IF 2.7 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Diagnostic and interventional radiology Pub Date : 2026-09-23 DOI:10.4274/dir.2026.264219

Nurper Denizoğlu, Füsun Taşkın, Gül Esen İçten, Ayşenur Oktay, Özge Aslan, Nermin Tunçbilek, Pınar Balcı, Erkin Arıbal, Levent Çelik, Şebnem Örgüç, Figen Demirkazık, Serap Gültekin, Ayşe Murat Aydın, Emel Durmaz, Sibel Kul, Figen Binokay, Meltem Çetin, Ganime Dilek Emlik, Meltem Gülsün Akpınar, Nuray Voyvoda, Ahmet Veysel Polat, Işıl Başara Akın, Şeyma Yıldız, Necdet Poyraz, Arzu Özsoy, Pelin Öztekin, Eda Elverici, İlkay Koray Bayrak, Türkan İkizceli, Alev Dolu, Funda Dinç, Gülten Sezgin, Gökçe Gülşen, Işıl Tunçbilek, Sabiha Rabia Yalçın, Gül Çolakoğlu, Serpil Ağlamış, Ravza Yılmaz, Günay Rona, Gamze Durhan, Davut Can Güner, Fatma Çelik Yabul, Leman Günbey Karabekmez, Burçin Tutar, Muhammet Göktaş, Onur Buğdaycı, Fatma Tokat, Mustafa Ege Şeker, Cihan Uras

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引用次数: 0

Abstract

Purpose: This study aimed to determine malignant, high-risk, and overall diagnostic upgrade rates after surgical excision of image-guided biopsy-proven intraductal papillomas and to identify factors associated with overall diagnostic upgrade.

Methods: In this retrospective multicenter study, 527 surgically excised papillary lesions from 30 centers were evaluated. Malignant upgrade was defined as malignancy at excision after a biopsy diagnosis of papilloma with or without atypia; high-risk upgrade was defined as a high-risk lesion at excision after papilloma without atypia. Overall diagnostic upgrade comprised either outcome. Multivariable logistic regression assessed age, lesion size, risk status, presence of symptoms, and radiologic-pathologic concordance.

Results: Papilloma without atypia accounted for 407 lesions, and papilloma with atypia for 120. The overall malignant upgrade rate was 21.4% (113/527). Among papillomas without atypia, high-risk and malignant upgrade rates were 19.7% (80/407) and 14.2% (58/407), respectively; among papillomas with atypia, malignant upgrade was 45.8% (55/120). Overall diagnostic upgrade occurred in 36.6% (193/527). Multivariable analysis identified older age [odds ratio (OR), 1.03 per year; 95% confidence interval (CI), 1.02-1.05], larger lesion size (OR, 1.02 per mm; 95% CI, 1.00-1.03), presence of symptoms (OR, 1.69; 95% CI, 1.15-2.49), and radiologic-pathologic discordance (concordance OR, 0.54; 95% CI, 0.35-0.84) as independent predictors of upgrade. Microcalcifications (OR, 2.47; 95% CI, 1.27-4.85) and asymmetry (OR, 2.18; 95% CI, 1.12-4.25) on mammography were also significantly associated with upgrade.

Conclusion: In this retrospective multicenter cohort of surgically excised, biopsy-proven papillary lesions, atypia and several clinical and imaging factors were associated with diagnostic upgrade. These findings may support individualized management decisions in patients with papillary breast lesions.

Clinical significance: Identifying clinical and imaging predictors of upgrade may facilitate risk-adapted management of papillary breast lesions and help avoid unnecessary surgical excision in carefully selected patients.

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乳房乳头状瘤手术切除后组织学升级的相关因素：一项回顾性多中心研究。

目的：本研究旨在确定图像引导下活检证实的导管内乳头状瘤手术切除后的恶性、高风险和总体诊断升级率，并确定与总体诊断升级相关的因素。方法：在这项回顾性多中心研究中，对来自30个中心的527例手术切除的乳头状病变进行评估。恶性升级定义为活检诊断乳头状瘤伴或不伴非典型性后切除的恶性；高风险升级定义为乳头状瘤切除后无异型性的高风险病变。总体诊断升级包括任一结果。多变量logistic回归评估了年龄、病变大小、危险状态、症状的存在和影像学病理一致性。结果：无异型性乳头状瘤407例，有异型性乳头状瘤120例。总体恶性升级率为21.4%（113/527）。无异型性的乳头瘤高危升级率为19.7%(80/407)，恶性升级率为14.2% (58/407)；在非典型性乳头瘤中，恶性升级率为45.8%（55/120）。总体诊断升级发生在36.6%（193/527）。多变量分析确定年龄较大[比值比（OR）， 1.03 /年；95%可信区间（CI）， 1.02-1.05]、较大的病变大小（OR, 1.02 / mm; 95% CI, 1.00-1.03）、症状的存在（OR, 1.69; 95% CI, 1.15-2.49）和影像学-病理不一致（一致性OR， 0.54; 95% CI, 0.35-0.84）是升级的独立预测因子。乳房x光检查的微钙化（OR, 2.47; 95% CI, 1.27-4.85）和不对称（OR, 2.18; 95% CI, 1.12-4.25）也与升级显著相关。结论：在这个回顾性的多中心队列中，手术切除、活检证实的乳头状病变、非典型性和一些临床和影像学因素与诊断升级有关。这些发现可能支持乳头状乳腺病变患者的个体化治疗决策。临床意义：确定升级的临床和影像学预测因素可能有助于对乳头状乳腺病变进行风险适应管理，并有助于避免对精心挑选的患者进行不必要的手术切除。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diagnostic and interventional radiology Medicine-Radiology, Nuclear Medicine and Imaging

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4.80%

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期刊介绍： Diagnostic and Interventional Radiology (Diagn Interv Radiol) is the open access, online-only official publication of Turkish Society of Radiology. It is published bimonthly and the journal’s publication language is English. The journal is a medium for original articles, reviews, pictorial essays, technical notes related to all fields of diagnostic and interventional radiology.