Hong Young Ran, Song Byung Joo, Jung Sang Seol, Kang Bong Joo, Kim Sung Hun, Chae Byung Joo
Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.
J Breast Cancer. 2016 Dec;19(4):410-416. doi: 10.4048/jbc.2016.19.4.410. Epub 2016 Dec 23.
Intraductal papilloma (IDP) is a benign breast disease with malignant potential, for which complete surgical excision is usually recommended. The aim of the present study was to investigate predictive factors for upgrading patients with a benign papillary lesion (BPL).
This study was an observational study using a prospectively collected cohort. In total, 13,049 patients who underwent a core needle biopsy (CNB) for a breast lesion between January 2009 and May 2015 were enrolled. We reviewed all patients with pathologically confirmed BPL from a CNB.
Surgical treatment was performed for 363 out of a total of 592 lesions. According to the pathological differences, the lowest upgrade rate was shown in IDP without atypia (without atypia, 6.0%; with atypia, 26.8%; papillary neoplasm, 31.5%; <0.001). The univariate analysis showed that, in IDP without atypia, the age at diagnosis, size of BPL on ultrasonography, and density on mammography were associated with upgrading. The multivariate analysis revealed that age >54 years and lesion size >1 cm were significantly associated with upgrade to malignancy (odds ratio [OR]=4.351, =0.005 and OR=4.236, =0.001, respectively).
The indications for surgical treatment can be defined as age >54 years and mass size >1 cm, even in IDP without atypia in the CNB results; this also includes cases of IDP with atypia or papillary neoplasm. Therefore, we suggest that close observation without surgery is sufficient for younger women with a small IDP without atypia.
导管内乳头状瘤（IDP）是一种具有恶性潜能的良性乳腺疾病，通常建议进行完整的手术切除。本研究的目的是调查良性乳头状病变（BPL）患者病情升级的预测因素。
本研究是一项使用前瞻性收集队列的观察性研究。总共纳入了2009年1月至2015年5月间因乳腺病变接受粗针穿刺活检（CNB）的13049例患者。我们回顾了所有经病理证实为BPL的CNB患者。
在总共592个病变中，363个进行了手术治疗。根据病理差异，无异型增生的IDP升级率最低（无异型增生，6.0%；有异型增生，26.8%；乳头状肿瘤，31.5%；P<0.001）。单因素分析显示，在无异型增生的IDP中，诊断时的年龄、超声检查中BPL的大小以及乳腺X线摄影的密度与病情升级有关。多因素分析显示，年龄>54岁和病变大小>1 cm与恶性升级显著相关（优势比[OR]=4.351，P=0.005；OR=4.236，P=0.001）。
手术治疗的指征可定义为年龄>54岁和肿块大小>1 cm，即使CNB结果显示无异型增生的IDP；这也包括有异型增生的IDP或乳头状肿瘤的病例。因此，我们建议对于年龄较小、无异型增生的小IDP女性，密切观察而不进行手术就足够了。
