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Patients with benign papilloma diagnosed on core biopsies and concordant pathology-radiology findings can be followed: experiences from multi-specialty high-risk breast lesion conferences in an academic center

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Abstract

Background

To determine whether patients with benign papilloma diagnosed on core biopsy can be spared from surgery.

Methods

We prospectively reviewed 150 consecutive core biopsy-diagnosed papilloma cases at a multi-specialty high-risk breast lesion conference to determine whether surgical excision was necessary. Of these 150 cases, 148 had concordant radiologic-pathologic features. Six were excluded due to lack of the first imaging follow-up until analysis. 112 were benign papillomas; 17 were papillomas involved by atypical ductal hyperplasia (atypical papilloma); 6 papillomas had ADH in adjacent tissue but not involving the papilloma; 2 papillomas were involved by atypical lobular hyperplasia (ALH); and 5 papillomas had ALH in adjacent tissue. Two were radiology-pathology (rad-path) discordant.

Results

Thirty-nine of the 112 benign papillomas were excised with no upgrade to carcinoma; 73 were followed with no disease progression during follow-up (185–1279 days). Fifteen of 17 atypical papillomas were surgically excised with 4 (26.7%) upgraded to carcinoma. Four of the 6 patients with ADH adjacent to a benign papilloma underwent excision with 2 upgrades to carcinoma. None of the patients with papilloma, which was either involved by ALH or had ALH in adjacent tissue had upgrade or disease progression during follow-up (204–1159 days). Finally, the two cases with discordant path-rad discordant were excised with no upgrade.

Conclusions

Our data confirm that rad-path concordant benign papillomas diagnosed on core biopsy do not require surgery. It also supports the value of a formal multi-specialty review of all benign papilloma cases to create a consensus management plan.

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Funding

Zhongliang Ma is supported by the Science and Technology Project for Colleges of Shandong Province (Grant No. J18KB111).

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Authors and Affiliations

  1. Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China

    Zhongliang Ma & Haibo Wang

  2. Department of Surgery, Emory University, Atlanta, GA, USA

    Cletus A. Arciero & Toncred M. Styblo

  3. Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road, Atlanta, GA, USA

    Michael A. Cohen

  4. Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Road, Atlanta, GA, 30322, USA

    Xiaoxian Li

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  1. Zhongliang Ma
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  2. Cletus A. Arciero
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  3. Toncred M. Styblo
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  4. Haibo Wang
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  5. Michael A. Cohen
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  6. Xiaoxian Li
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Contributions

Conception and design: All authors. Analysis and interpretation of data: All authors. Manuscript drafting and reviewing: All authors. XL is responsible for the overall content.

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Correspondence to Michael A. Cohen or Xiaoxian Li.

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Ma, Z., Arciero, C.A., Styblo, T.M. et al. Patients with benign papilloma diagnosed on core biopsies and concordant pathology-radiology findings can be followed: experiences from multi-specialty high-risk breast lesion conferences in an academic center. Breast Cancer Res Treat 183, 577–584 (2020). https://doi.org/10.1007/s10549-020-05803-2

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