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Management of papillary lesions without atypia of the breast diagnosed on needle biopsy
Author(s) -
Yu Yue,
Salisbury Elizabeth,
GordonThomson David,
Yang JiaLin,
Crowe Philip J.
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14827
Subject(s) - medicine , atypia , malignancy , biopsy , radiology , ductal carcinoma , breast cancer , pathology , cancer
Background Current surgical practice often leads to excision of all papillary lesions of the breast diagnosed on percutaneous biopsy. This study aims to identify a subset of patients with papillary lesions who may be able to avoid surgery. Methods Between January 2000 and December 2015, 157 cases of papillary lesions with complete surgical excision pathology results were reviewed retrospectively to compare the clinical, imaging and pathology features. Of these, 50 patients with benign papillary lesions without atypia and 19 patients with benign papillary lesions with atypia on needle biopsy were analysed to determine the rate of upgrade to malignancy after surgery. Results Of the 50 patients with benign papillary lesions without atypia on biopsy, two (4%) were upgraded to low grade ductal carcinoma in situ after surgical excision. Both these patients had suspicious features on imaging. Of the 19 patients with papillary lesions with atypia diagnosed on needle biopsy, eight (42%) were upgraded to malignancy after surgery. The differences between benign, atypical and malignant papillary lesions were further compared. Malignant lesions were more suspicious radiologically ( P = 0.001), more likely to have architectural distortion ( P = 0.001), more peripherally located ( P = 0.001) and were larger in size ( P = 0.01). Patients diagnosed with malignant lesions were also older ( P = 0.001). Conclusion Younger patients diagnosed with small central benign papillary lesions without atypia on needle biopsy, and without suspicious imaging, may be managed conservatively with surveillance.