Tatarian Talar, Sokas Claire, Rufail Miguel, Lazar Melissa, Malhotra Sanchi, Palazzo Juan P, Hsu Elizabeth, Tsangaris Theodore, Berger Adam C
Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Ann Surg Oncol. 2016 Aug;23(8):2501-7. doi: 10.1245/s10434-016-5182-7. Epub 2016 Mar 9.
The management of intraductal papillomas on core biopsy continues to be controversial. Papillomas with atypia are typically excised. However, it is unclear whether surgical excision is warranted for benign lesions.
A retrospective review of our institution's pathology and radiology databases from January 2009 through May 2014 identified 119 patients with a diagnosis of benign papilloma without atypia on core biopsy. We determined the rate of carcinoma identification on surgical excision.
The average patient age was 52.8 years (range 24-84 years). Indication for core biopsy included: abnormal imaging (n = 106), nipple discharge (n = 21), or palpable mass (n = 24). Seventy-five patients underwent surgical excision after core biopsy. Sixteen patients (21.3 %) had atypia in the excision specimen (combination atypical ductal hyperplasia, n = 11; atypical lobular hyperplasia, n = 8; lobular carcinoma-in situ, n = 3), 15 (93.8 %) of which were in the surrounding breast tissue. Two patients (2.7 %) had malignancy (ductal carcinoma-in situ and micropapillary carcinoma-in situ). As a result of surgical findings, 12 % of patients had a change in management. In comparing those with benign findings on surgical pathology and those whose disease was upstaged, there was no statistically significant difference in family history of breast cancer, indication for core biopsy, mammographic findings, or location of papilloma.
Benign papillomas diagnosed on core biopsy are rarely upstaged to malignancy on surgical excision. However, at least 21 % of patients may have atypical findings in the surrounding tissue, which could change clinical management. Surgical excision should be considered in patients with benign papillomas.
粗针活检诊断为导管内乳头状瘤的处理仍存在争议。伴有非典型性的乳头状瘤通常需切除。然而，对于良性病变是否有必要进行手术切除尚不清楚。
回顾性分析我院2009年1月至2014年5月的病理和放射学数据库，确定119例粗针活检诊断为无非典型性的良性乳头状瘤患者。我们确定了手术切除时发现癌变的比例。
患者平均年龄为52.8岁（范围24 - 84岁）。粗针活检的指征包括：影像学异常（n = 106）、乳头溢液（n = 21）或可触及肿块（n = 24）。75例患者在粗针活检后接受了手术切除。16例患者（21.3%）切除标本中有非典型性（非典型性导管增生，n = 11；非典型性小叶增生，n = 8；小叶原位癌，n = 3），其中15例（93.8%）位于周围乳腺组织。2例患者（2.7%）有恶性肿瘤（导管原位癌和微乳头原位癌）。根据手术结果，12%的患者治疗方案有改变。比较手术病理结果为良性的患者和疾病分期上调的患者，在乳腺癌家族史、粗针活检指征、乳腺X线摄影结果或乳头状瘤位置方面，差异无统计学意义。
粗针活检诊断为良性的乳头状瘤手术切除时很少上调为恶性肿瘤。然而，至少21%的患者周围组织可能有非典型性发现，这可能改变临床处理。对于良性乳头状瘤患者应考虑手术切除。
