Gillani Mishal, Idress Romana, Afzal Shaista, Khan Maria, Shahzad Hania, Sattar Abida K
Department of Medicine, Aga Khan University Hospital, Karachi, PAK.
Department of Histopathology, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2024 Feb 22;16(2):e54716. doi: 10.7759/cureus.54716. eCollection 2024 Feb.
Introduction Management of intraductal papillomas (IDPs) diagnosed on core needle biopsy (CNB) remains controversial. We report our experience of IDPs identified on CNB, our institutional rates of upgradation to atypia/malignancy as well as radiologic/pathologic features that may allow selection for surgery as well as those for safe observation. Methods The study is a retrospective review of patient records from 2012 to 2019, at a tertiary care hospital in Pakistan. Data was analyzed using Statistical Package for Social Sciences (SPSS), version 21.0 (IBM Corp., Armonk, NY). Associations between various patient factors were assessed using Pearson's chi-square test. Results This study included a total of 55 female patients with IDPs, with a mean age of 54.67 ± 15.57 years. On CNB, 69.1% (n = 38) of patients had IDP without atypia while 30.9% (n = 17) had IDP with atypia, with single IDPs being the most common lesions on excisional biopsy. Overall, of all CNB-diagnosed IDPs, only 4/55 (7.3%) demonstrated upgradation (3/4 to DCIS, 1/4 showed atypia) on excisional biopsy, and all these upgraded cases had failed to demonstrate atypia on initial CNB. Conclusion CNB-identified cases of IDPs are rarely upgraded on excision and thus routine excision in all cases may be unnecessary. Appropriate patient selection based on radiology-pathology findings should be done. Those with suspicious findings on imaging as well as those that demonstrate atypia on CNB must be excised.
引言 经粗针穿刺活检（CNB）诊断出的导管内乳头状瘤（IDP）的管理仍存在争议。我们报告了我们在CNB上识别出IDP的经验、我们机构将其升级为非典型增生/恶性肿瘤的发生率，以及可能有助于选择手术或安全观察的放射学/病理学特征。方法 本研究是对巴基斯坦一家三级医院2012年至2019年患者记录的回顾性分析。使用社会科学统计软件包（SPSS）21.0版（IBM公司，纽约州阿蒙克）进行数据分析。使用Pearson卡方检验评估各种患者因素之间的关联。结果 本研究共纳入55例患有IDP的女性患者，平均年龄为54.67±15.57岁。在CNB上，69.1%（n = 38）的患者患有无非典型增生的IDP，而30.9%（n = 17）的患者患有非典型增生的IDP，单个IDP是切除活检中最常见的病变。总体而言，在所有经CNB诊断的IDP中，只有4/55（7.3%）在切除活检时显示升级（3/4升级为导管原位癌，1/4显示非典型增生），所有这些升级病例在初次CNB时均未显示非典型增生。结论 CNB识别出的IDP病例在切除时很少升级，因此可能无需对所有病例进行常规切除。应根据放射学-病理学结果进行适当的患者选择。影像学上有可疑发现以及CNB上显示非典型增生的患者必须进行切除。
