Mount Sinai Hospital, Dubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Cancer Rep (Hoboken). 2022 Mar;5(3):e1481. doi: 10.1002/cnr2.1481. Epub 2021 Nov 2.
Management of pure intraductal papillomas (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial given highly variable rates of upgrade in the literature.
We sought to identify clinical and histologic factors that predict upgrade to atypia or malignancy in a large population.
A retrospective review was performed of all cases of pure IDP diagnosed on CNB and then surgically excised at a single institution from 2008 to 2018. Clinical, radiologic, and pathologic factors were compared in the no upgrade, upgrade to atypia, or upgrade to cancer groups. Univariate analysis was performed comparing no upgrade and upgrade to cancer or atypia. Four hundred and thirty nine patients were identified with a total of 490 IDP and a median age of 50 years (range 16-85). Of these patients, 54 (12.3%) were upgraded to atypia after surgical excision and five (1.1%) were upgraded to cancer. The presence of multiple papillomas in a single patient was a significant predictor of upgrade to cancer or atypia (p < .01), as well as age over ≥55 years (p < .01) and a prior history of cancer (p < .01). No other clinical, radiologic and histologic factors were found to be significant predictors of upgrade. 40/439 (9.1%) patients in the total cohort had prior history of cancer, and of these, 2/40 (5%) were found to have a new cancer after excision.
In patients with pure IDP on CNB, the upgrade rate to malignancy was 1.1%, while 12.3% were upgraded to atypia. The clinical significance of identifying atypia in a papilloma is unknown, especially in a patient with a prior history of atypia or cancer. However, the majority of patients who were upgraded to either atypia or cancer had no prior history of high-risk or malignant breast disease and are therefore considered true clinical upgrades. As such excision for IDP should be considered.
对于在核心针活检 (CNB) 上诊断为单纯导管内乳头状瘤 (IDP) 且无非典型性的患者，由于文献中升级率差异很大，其管理仍存在争议。
我们旨在确定可预测大量人群中向非典型性或恶性病变升级的临床和组织学因素。
对 2008 年至 2018 年在一家机构通过 CNB 诊断并随后手术切除的所有单纯 IDP 病例进行回顾性分析。比较无升级、升级为非典型性或升级为癌症组的临床、影像学和病理学因素。对无升级和升级为癌症或非典型性进行单变量分析。共确定 439 例患者，共 490 例 IDP，中位年龄为 50 岁（范围 16-85 岁）。这些患者中有 54 例（12.3%）在手术切除后升级为非典型性，5 例（1.1%）升级为癌症。单个患者中存在多个乳头状瘤是升级为癌症或非典型性的显著预测因素（p<0.01），年龄≥55 岁（p<0.01）和既往癌症史（p<0.01）也是显著预测因素。未发现其他临床、影像学和组织学因素是升级的显著预测因素。在总队列的 439 例患者中，有 40 例（9.1%）有既往癌症史，其中 2 例（5%）在切除后发现新癌症。
在 CNB 上诊断为单纯 IDP 的患者中，恶性肿瘤升级率为 1.1%，而非典型性升级率为 12.3%。在有乳头状瘤非典型性病史的患者中发现非典型性的临床意义尚不清楚，尤其是在有非典型性或癌症病史的患者中。然而，大多数升级为非典型性或癌症的患者既往无高危或恶性乳腺疾病史，因此被认为是真正的临床升级。因此，应考虑切除 IDP。
