# Management of Breast Intraductal Papilloma Diagnosed on Core Needle Biopsy: Excision or Follow-up?

## TL;DR

This study examines whether all breast intraductal papillomas diagnosed via biopsy need surgery or if some can be safely observed.

## Contribution

The study provides institutional data on upgrade rates and identifies criteria for selecting patients for surgery or follow-up.

## Key findings

- Only 7.3% of intraductal papillomas diagnosed via core needle biopsy showed upgradation on excision.
- All upgraded cases lacked atypia on initial biopsy, suggesting routine excision may not be necessary.
- Patients with suspicious imaging or atypia on biopsy should be considered for excision.

## Abstract

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.