Upgrade rate of intraductal papilloma without atypia on breast core needle biopsy: A clinical, radiological and pathological correlation study

The aim of the study was to determine the upgrade rate on excision of intraductal papilloma (IDP) without atypia diagnosed on breast core needle biopsy (CNB). We searched our pathology department database for breast CNB with a diagnosis of IDP from 2013 to 2018. The exclusion criteria included radiologic-pathologic discordance, atypia on the same CNB, absence of histologic slides to review or absence of excision information. Upgrade was defined as ductal carcinoma in situ (DCIS) or invasive cancer identified on excision. 126 IDP without atypia cases from 94 patients were identified. The upgrade rate was 1.58% (2/126). Both upgrade cases showed DCIS with low and intermediate nuclear grade. Histologic size of IDP ≥1 cm was the only statistically significant predictor factor for an upgrade on excision. The results suggest that non-surgical management of patients with radiologic-pathologic concordant IDP without atypia diagnosed on CNB may be appropriate in routine practice. •Benign intraductal papilloma on core biopsy has a very low upgrade rate on excision.•Two of 126 (%1.58) intraductal papilloma showed DCIS on surgical excision.•Intraductal papilloma ≥1 cm on microscopy was associated with a higher upgrade rate.•Non-surgical management may be appropriate for benign intraductal papilloma. The current study showed a very low upgrade rate (1.58%) on excision of benign intraductal papilloma diagnosed on breast core needle biopsy with a radiologic-pathologic concordance. The findings suggest that non-surgical management of these patients may be appropriate in routine practice.