Multidisciplinary Review of Intraductal Papilloma of the Breast can Identify Patients who may Omit Surgical Excision.

Autor: Abbassi-Rahbar S; Department of Surgery, The University of Kansas Health System, Kansas City, KS, USA., Sack S; University of Kansas Medical Center, Kansas City, KS, USA., Larson KE; Department of Surgery, The University of Kansas Health System, Kansas City, KS, USA., Wagner JL; Department of Surgery, The University of Kansas Health System, Kansas City, KS, USA., Kilgore LJ; Department of Surgery, The University of Kansas Health System, Kansas City, KS, USA., Balanoff CR; Department of Surgery, The University of Kansas Health System, Kansas City, KS, USA., Winblad OD; Department of Radiology, The University of Kansas Health System, Kansas City, KS, USA., Amin AL; Department of Surgery, The University of Kansas Health System, Kansas City, KS, USA. aamin624@gmail.com.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2021 Oct; Vol. 28 (10), pp. 5768-5774. Date of Electronic Publication: 2021 Aug 02.
DOI: 10.1245/s10434-021-10520-1
Abstrakt: Background: The purpose of this study was to define contemporary management recommendations regarding who would benefit from surgical excision of intraductal papilloma (IDP).
Methods: A prospective database from a single institution identified patients with IDP on percutaneous biopsy from February 2015 to September 2020. Categorical patient demographic, biopsy, and pathologic variables were analyzed using Fisher's exact test and continuous demographic and imaging variables using the Mann-Whitney U test.
Results: IDP was present in 416 biopsies, at a median age of 56 years. The median size was 0.9 cm, and the majority had greater than 50% of the target excised by biopsy. Surgical excision was performed for 124 of 416 biopsies (29.8%). Upgrade to malignancy was identified in 14 (11.3%): 8 to ductal carcinoma in situ (DCIS) and 6 to invasive cancer. Upgrade was significantly associated with concurrent ipsilateral breast cancer (p = 0.027), larger imaging size (p = 0.045), <50% excised with biopsy (p = 0.02), and atypia involving IDP (p = 0.045). Age, clinical presentation, and concurrent contralateral cancer were not significantly associated with upgrade. Lowest upgrade risk (0%) was in pure IDP ≤1 cm with >50% removed by biopsy. Of 401 biopsies that either did not upgrade or undergo excision, 7 (1.7%) developed subsequent breast cancer over a median follow-up of 23.5 months (interquartile range [IQR] 11,41), none at IDP site.
Conclusions: After multidisciplinary review, the management of IDP can be stratified into low- and high-risk for upgrade groups using key criteria. Low-risk group may omit surgical excision, because those patients have 0% risk of upgrade over the limited short-term follow-up.
(© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)
Databáze: MEDLINE
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