Khan Sidrah, Diaz Adrian, Archer Kellie J, Lehman Rebecca R, Mullins Tiffany, Cardenosa Gilda, Bear Harry D
Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Breast J. 2018 May;24(3):350-355. doi: 10.1111/tbj.12907. Epub 2017 Aug 27.
Papillary lesions of the breast range from benign to atypical to malignant. Although papillomas without frank cancer are benign, their management remains controversial. When a core needle biopsy of a lesion yields a diagnosis of intraductal papilloma with atypia, excision is generally recommended to rule out a concurrent malignant neoplasm. For intraductal papillomas without atypia, however, recommendations for excision versus observation are variable. The aims of this study are to evaluate the rate of concurrent malignancies for intraductal papilloma diagnosed on core needle biopsy and to assess the long-term risk of developing cancer after the diagnosis of a papillary lesion. This single institution retrospective study analyzed 259 patients that were diagnosed with intraductal papilloma (IDP) by core needle biopsy from 1995 to 2010. Patients were grouped by initial diagnosis into three groups (papilloma without atypia, papilloma with atypia, and papilloma with atypical duct hyperplasia or atypical lobular hyperplasia (ADH/ALH) and followed up for long-term outcomes. After a core needle biopsy showing IDP with atypia or IDP + ADH/ALH, surgical excision yielded a diagnosis of concomitant invasive or ductal in situ cancer in greater that 30% of cases. For intraductal papilloma without atypia, the likelihood of cancer was much lower. Moreover, even with excision, the finding of intraductal papilloma with atypia carries a significant risk of developing cancer long-term, and such patients should be followed carefully and perhaps should be considered for chemoprevention.
乳腺乳头状病变涵盖从良性到非典型再到恶性的范围。尽管无明显癌症的乳头状瘤是良性的，但其处理方式仍存在争议。当对病变进行粗针活检诊断为非典型性导管内乳头状瘤时，通常建议进行切除以排除同时存在的恶性肿瘤。然而，对于无非典型性的导管内乳头状瘤，切除与观察的建议并不统一。本研究的目的是评估粗针活检诊断为导管内乳头状瘤时同时存在恶性肿瘤的发生率，并评估乳头状病变诊断后发生癌症的长期风险。这项单机构回顾性研究分析了1995年至2010年间通过粗针活检诊断为导管内乳头状瘤（IDP）的259例患者。患者根据初始诊断分为三组（无非典型性的乳头状瘤、有非典型性的乳头状瘤、伴有非典型性导管增生或非典型性小叶增生（ADH/ALH）的乳头状瘤），并对长期结果进行随访。在粗针活检显示为非典型性IDP或IDP + ADH/ALH后，手术切除在超过30%的病例中诊断出同时存在浸润性癌或导管原位癌。对于无非典型性的导管内乳头状瘤，发生癌症的可能性要低得多。此外，即使进行了切除，发现非典型性导管内乳头状瘤仍有长期发生癌症的重大风险，此类患者应仔细随访，或许应考虑进行化学预防。
