Abstract P2-13-19: Papillary breast lesions: Association with malignancy and upgrade rates on surgical excision
Authors: Mursleen Asma , Tran Hanh Tam , Ghanem Omar M , Farha Maen 
Published: May 2015

Abstract
Introduction: The management of benign intraductal papillary (IDP) lesions is controversial. Radiological and clinical findings alone cannot distinguish benign or malignant IDPs. Surgical excision of IDPs diagnosed by core or vacuum assisted biopsies was the standard of practice. There is an increasing body of literature suggesting that observation may suffice.
Design: This study investigated upgrade rates of benign IDPs on surgical excision. A listing of all cases where the pathology report included Papillary or papilloma was obtained after IRB approval. The upgrade rate on excised lesions and the association of IDPs with atypia and malignancy were assessed. Clinical and radiological presentations of papillary lesions was obtained from the medical records. We also reviewed recently published data on the subject for comparison.
Results: We reviewed 65 pathology reports of IDPs diagnosed at our institution between 2011-2014. Papillary lesions were stratified in to three categories: benign, associated with atypia and associated with malignancy. Upgrade rates on surgical excision of benign IDPs diagnosed with core biopsy was calculated. Of the 65 papillary lesions 67.7% were benign, 10.8% were associated with atypia, and 21.5% were associated with malignancy. The upgrade rate on 28 excised benign IDPs was 7.14%.
A review of 15 studies published between 2011-14 on IDPs shows an average upgrade rate of 17% in the routine excision group versus 2% in the observation group.
Intraductal Papillomas and upgrade rates on excision Upgrade rate(%) in the routine excision studiesUpgrade rates(%) in the observation group 190 68.9 390 191.6 230 3.10 11.53.8 0 Numb of studies78Average rate17.231.79
Clinical presentation included: Palpable mass, nipple discharge, itching, mammographic mass/asymmetry or calcifications. This study found 69.3% of papillary lesions presented as mammographic findings including nodules/asymmetry (28%), calcifications (24%), masses (16.7%). The remaining 29.3% of the papillary lesions presented as palpable masses(14.7%), discharge (4%), itching (2.67%), and pain/tenderness(1.3%).
Conclusion: IDPs present as a radiologic finding in 2/3 of the cases and a clinical complaint in the remaining patients. A review of the upgrade rates in the literature shows a range of 0-39%. Although larger cores from vacuum assisted biopsies may lower the upgrade rates, a good number of studies show rates that do not justify observation only. As concerning is the association of papillary lesions with atypia and malignancy in 32.3% of our patients indicating a possible causal relation. Our data and review of the literature indicate that short of a prospective randomized trial to settle this question, IDPs should be routinely excised.
Citation Format: Asma Mursleen, Hanh Tam Tran, Omar M Ghanem, Maen Farha. Papillary breast lesions: Association with malignancy and upgrade rates on surgical excision [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-19.