Han Song-Hee, Kim Milim, Chung Yul Ri, Yun Bo La, Jang Mijung, Kim Sun Mi, Kang Eunyoung, Kim Eun-Kyu, Park So Yeon
Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Pathology, Konyang University Hospital, Daejeon, Korea.
J Breast Cancer. 2018 Mar;21(1):80-86. doi: 10.4048/jbc.2018.21.1.80. Epub 2018 Mar 23.
The management of benign intraductal papilloma (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial. This study was performed to evaluate the rate of upgrading to malignancy or high-risk lesions after excision and to identify factors associated with upgrading using a large series of benign IDP cases without atypia.
We included patients who were diagnosed as having benign IDP without atypia on CNB and underwent surgical or vacuum-assisted excision between 2010 and 2015. We analyzed the clinical, radiologic, and histopathologic features of IDPs that were upgraded to malignancy or high-risk lesions after excision.
A total of 511 benign IDPs without atypia diagnosed via CNB were identified, of which 398 cases were treated with excision. After reviewing these cases, four cases of high-risk lesions in adjacent tissue on CNB, two cases which were revealed as papilloma with atypia, and nine cases of malignancy in the same breast were excluded. In the remaining 383 cases, the rate of upgrading to malignancy and high-risk lesions after excision was 0.8% and 4.4%, respectively. The presence of concurrent contralateral breast cancer, the presence of symptoms, and multifocality were factors significantly associated with upgrading to malignancy on subsequent excision. Surgical excision rather than vacuum-assisted excision was significantly associated with upgrading to high-risk lesions or malignancy.
The rate of upgrading to malignancy for benign IDP without atypia was very low, suggesting that close clinical and radiologic observation may be sufficient for patients with benign IDP without atypia on CNB under proper settings.
对于在粗针活检（CNB）中诊断为无异型性的良性导管内乳头状瘤（IDP），其管理仍存在争议。本研究旨在评估切除术后升级为恶性肿瘤或高危病变的发生率，并使用大量无异型性的良性IDP病例来确定与升级相关的因素。
我们纳入了在2010年至2015年间经CNB诊断为无异型性的良性IDP且接受了手术或真空辅助切除的患者。我们分析了切除术后升级为恶性肿瘤或高危病变的IDP的临床、放射学和组织病理学特征。
共识别出511例经CNB诊断为无异型性的良性IDP，其中398例接受了切除治疗。在回顾这些病例后，排除了4例CNB显示相邻组织为高危病变的病例、2例显示为异型性乳头状瘤的病例以及9例同侧乳房恶性肿瘤的病例。在其余383例病例中，切除术后升级为恶性肿瘤和高危病变的发生率分别为0.8%和4.4%。对侧乳腺癌的存在、症状的存在以及多灶性是与后续切除时升级为恶性肿瘤显著相关的因素。手术切除而非真空辅助切除与升级为高危病变或恶性肿瘤显著相关。
无异型性的良性IDP升级为恶性肿瘤的发生率非常低，这表明在适当的情况下，对于CNB显示无异型性的良性IDP患者，密切的临床和放射学观察可能就足够了。
