Intraductal papillomas of the breast

: Papillary lesions of the breast are classified as benign or malignant. Making a definitive diagnosis for a papillary lesion based on a core needle biopsy remains a challenge for pathologists. Intraductal papillomas are a common benign lesion of the breast with variable presentations. They may be identified with or without atypia and may present with or without symptoms, often identified on breast imaging. Patients with intraductal papillomas with atypia should be referred for surgical excision due to the higher rate of upstaging to malignancy and they should also be referred for high risk assessment for possible chemoprevention. Unlike intraductal papillomas with atypia, there is no consensus for the management of intraductal papillomas without atypia and the management of intraductal papillomas without atypia has been controversial. Retrospective studies for intraductal papillomas without atypia have shown upstaging rates to carcinoma ranging from 0–33%. Excision can be considered for those patients presenting with symptoms such as palpable masses, nipple discharge or larger masses greater than 1 cm. Surgical excision is not indicated for asymptomatic intraductal papillomas without atypia where there is pathologic-radiographic concordance based on the prospective TBCRC 034 trial. The objective of this article is to review the current literature with series published over the last 5 years regarding intraductal papillomas with and without atypia and to summarize their management.