Breast Papillomas in the Era of Percutaneous Needle Biopsy

Vance Sohn3 , Joren Keylock1, Zachary Arthurs3, Aimee Wilson2, Garth Herbert3, Jason Perry3, Matthew Eckert3, Donald Smith2, Stephen Groo1 and Tommy Brown3

(1) Department of Pathology, Madigan Army Medical Center, Tacoma, Washington
(2) Department of Radiology, Madigan Army Medical Center, Tacoma, Washington
(3) Department of Surgery, Madigan Army Medical Center , Building 9040 Fitzsimmons Drive, Tacoma, WA, 98431, Washington

Received: 15 March 2007 Accepted: 6 May 2007 Published online: 5 June 2007

Abstract
Background The significance of breast papillomas detected on core needle biopsy (CNB) remains unclear. While those associated with malignancy or atypia are excised, no clear solution exists for benign papillomas. We sought to determine the indication for surgical excision, incidence of malignancy, significance, and natural history.
Methods In this retrospective review, patients were divided into benign, atypical, or malignant cohorts based on initial results. While patients with malignant or atypical features were encouraged to undergo surgical excision, no standard recommendation was given for benign papillomas. Mammographic features, method of initial diagnosis, pathology results, and follow-up data were analyzed.
Results Between January 1994 to December 2005, 5,257 CNBs were performed at our tertiary level medical center. 206 patients were diagnosed with 215 breast papillomas. 174 (81%) papillomas were benign, 26 (12%) were associated with atypia, and 15 (7%) were associated with malignancy. Two benign papillomas (1.1%) developed into cancer over an average of 53 months. Average follow-up of those patients not undergoing excision for benign papilloma was 41 months; we had 92 patients with greater than two year follow-up and 57 patients with greater than four year follow-up. Of patients with atypia or malignancy associated with papilloma, there was a 26% and 87% associated rate of malignancy, respectively.
Conclusions Benign breast papillomas diagnosed by CNB have a low risk of malignancy and do not need excision. However, they should be considered high risk lesions which require serial radiographic monitoring. Papillomas associated with atypia or malignancy should continue to be excised.
Keywords Breast papillomas - Papilloma - stereotactic core biopsy - Breast cancer