Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611.
Hum Pathol. 2014 Mar;45(3):583-8. doi: 10.1016/j.humpath.2013.10.027. Epub 2013 Nov 6.
Intraductal papillomas (IDPs) of the breast can be associated with a variety of clinical symptoms and radiologic findings. Surgical excision is often recommended based on the possibility of an associated high-grade lesion. Although the rate of upgrades has been extensively evaluated for IDPs, many studies are hindered by broad inclusion criteria, a lack of pathologic-radiologic concordance, and no standard definition of what constitutes an upgrade. In the current study, we evaluate the risk of upgrade for a specific subset of IDPs: non-mass-associated IDPs. We identified all breast needle core biopsies with a diagnosis of IDP between 2003 and 2010. Patients with associated masses, architectural distortion, or ipsilateral breast cancer were excluded. All needle core biopsy slides and relevant imaging studies were reviewed to ensure pathologic-radiologic concordance. Excision pathology was also reviewed; an upgrade was defined as the presence of ductal carcinoma in situ or invasive carcinoma in the excision. Seventy-nine IDPs that met inclusion criteria were identified and were further divided into 3 histologic categories: micropapilloma, fragmented IDP, and atypical IDP. Micropapillomas and fragmented IDPs had no upgrades (0/37). In patients who did not undergo excision, none subsequently developed ipsilateral breast cancer (follow-up, 50-61 months). This is in contrast to atypical IDPs that had a 33% upgrade rate. One patient with an unexcised atypical IDP developed ipsilateral breast cancer within 2 years. Our data suggest that conservative follow-up is reasonable for non-mass-associated IDPs without atypia regardless of microscopic size, provided that careful pathologic-radiologic correlation is achieved.
乳腺导管内乳头状瘤（IDP）可伴有多种临床症状和影像学表现。由于存在高级别病变的可能，常建议手术切除。尽管 IDP 的升级率已得到广泛评估，但许多研究受到广泛纳入标准、缺乏病理-影像学一致性以及缺乏明确的升级定义的限制。在本研究中，我们评估了一个特定的 IDP 亚组（非肿块相关 IDP）的升级风险。我们确定了 2003 年至 2010 年间所有诊断为 IDP 的乳腺针芯活检。排除了有肿块、结构扭曲或同侧乳腺癌的患者。所有针芯活检切片和相关影像学研究均进行了回顾，以确保病理-影像学一致。还回顾了切除病理学；升级定义为切除标本中存在导管原位癌或浸润性癌。符合纳入标准的 79 例 IDP 被确定，并进一步分为 3 种组织学类别：微乳头状瘤、碎裂性 IDP 和非典型 IDP。微乳头状瘤和碎裂性 IDP 无升级（37/37）。未行切除术的患者中，无一例随后发生同侧乳腺癌（随访 50-61 个月）。相比之下，非典型 IDP 的升级率为 33%。1 例未切除的非典型 IDP 在 2 年内发生同侧乳腺癌。我们的数据表明，对于无非典型性的非肿块相关 IDP，无论显微镜下大小如何，保守随访是合理的，前提是实现了仔细的病理-影像学相关性。
