Excision Advised for Papillary Breast Lesions

A retrospective study recommends surgical excision of all papillary breast lesions, including benign ones, since diagnosis via core-needle breast biopsy alone was found to be inadequate.

Researchers at New York Presbyterian Hospital at Columbia University (New York, USA) and New York University Medical Center (New York, USA) retrospectively examined the imaging and histologic follow-up findings of 43 biopsies in 42 women who were diagnosed with papillary lesions from 1997-2003 at the two institutions. After core-needle biopsies, 29 lesions were diagnosed as papilloma, eight as sclerosing papilloma, and six as benign papillary lesions not otherwise specified. Clinically, all lesions were nonpalpable, none of the patients had nipple discharge, and all 43 lesions were at least 2 cm from the nipple.

Of the 43 lesions, 36 were excised, and histologic examination showed that 26 were in fact benign. However, eight lesions were upgraded to papilloma with adjacent foci of atypical ductal hyperplasia, and another two to well-differentiated papillary ductal carcinoma in situ (DCIS). One woman had two tissue samples upgraded. In other words, 21.4% of the patients (nine of 42) actually had an atypical or malignant lesion. The results were reported in the March 2006 issue of Radiology.

All benign papillary lesions of the breast should be surgically excised, since a considerable number of atypical lesions and malignant lesions could be missed, said lead author Cecilia Mercado, M.D., of New York University Medical Center. In fact, she and her colleagues argue, the risk may be even greater than was shown because the study excluded women with nipple discharge or palpable masses.



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New York Presbyterian Hospital
New York University Medical Center