Analysis of 612 Benign Papillomas Diagnosed At Core Biopsy: Rate of Upgrade to Malignancy, Factors Associated with Upgrade, and A Proposal For Selective Surgical Excision
Despite numerous published studies, management of benign papillomas without atypia remains controversial. To determine the malignancy upgrade rate of benign papillomas, identify risk factors for upgrade, and formulate criteria for selective surgery. This retrospective study included benign papilloma...
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| Veröffentlicht in: | American journal of roentgenology (1976) 2021-12, Vol.217 (6), p.1299-1311 |
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| container_title | American journal of roentgenology (1976) |
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| creator | Lee, Su-Ju Wahab, Rifat A Sobel, Lawrence D Zhang, Bin Brown, Ann L Lewis, Kyle Vijapura, Charmi Mahoney, Mary C |
| description | Despite numerous published studies, management of benign papillomas without atypia remains controversial.
To determine the malignancy upgrade rate of benign papillomas, identify risk factors for upgrade, and formulate criteria for selective surgery.
This retrospective study included benign papillomas without atypia diagnosed on percutaneous biopsy between 12/01/2000 and 12/31/2019. Papillomas that did not undergo surgical excision or at least 2 years of imaging and/or clinical follow-up were excluded. Clinical, imaging, and histopathologic features were extracted from the electronic medical record. Features associated with upgrade to malignancy were identified. Multivariable logistic regression was performed.
The study included 612 benign papillomas in 543 women (mean age 54.5 ± 12.1 years); 466 papillomas were excised, and 146 underwent imaging/clinical surveillance. The upgrade rate to malignancy was 2.3% (14/612). Upgrade rate was associated (p |
| doi_str_mv | 10.2214/AJR.21.25832 |
| format | Article |
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To determine the malignancy upgrade rate of benign papillomas, identify risk factors for upgrade, and formulate criteria for selective surgery.
This retrospective study included benign papillomas without atypia diagnosed on percutaneous biopsy between 12/01/2000 and 12/31/2019. Papillomas that did not undergo surgical excision or at least 2 years of imaging and/or clinical follow-up were excluded. Clinical, imaging, and histopathologic features were extracted from the electronic medical record. Features associated with upgrade to malignancy were identified. Multivariable logistic regression was performed.
The study included 612 benign papillomas in 543 women (mean age 54.5 ± 12.1 years); 466 papillomas were excised, and 146 underwent imaging/clinical surveillance. The upgrade rate to malignancy was 2.3% (14/612). Upgrade rate was associated (p<.05) with radiology-pathology correlation (50.0% if discordant vs 2.1% if concordant), patient age (5.6% for age ≥60 vs 0.7% for age <60), presenting symptoms (6.7% if palpable mass or pathologic nipple discharge vs 1.3% if no symptoms), and lesion size (7.3% if ≥10 mm vs 0.6% if <10 mm). Three of 14 upgraded papillomas were associated with ≥4 metachronous or concurrent peripheral papillomas. No incidental papilloma or papilloma reported as completely excised on core biopsy histopathologic analysis was upgraded. A predictive model combining radiology-pathology discordance, symptoms (palpable mass or nipple discharge), age ≥60, size ≥10 mm, and presence of ≥4 metachronous or concurrent peripheral papillomas achieved AUC 0.91, sensitivity 79%, and specificity 89% for upgrade. Selective surgery based on presence of any of these five factors, while excluding from surgery incidental papillomas and papillomas reported as completely excised on histopathology, would spare 294 of 612 lesions from routine excision, while identifying all 14 upgraded lesions.
Benign non-atypical papillomas have a low malignancy upgrade rate; routine surgical excision may not be necessary. Selective excision is recommended for lesions satisfying any of the 5 criteria. Incidental papillomas or papillomas completely excised on histopathology may undergo imaging follow-up.
The proposed criteria for selective surgery of benign papillomas on core biopsy would reduce surgeries without delaying diagnosis of malignancy.</description><identifier>ISSN: 0361-803X</identifier><identifier>EISSN: 1546-3141</identifier><identifier>DOI: 10.2214/AJR.21.25832</identifier><identifier>PMID: 34008998</identifier><language>eng</language><publisher>United States</publisher><ispartof>American journal of roentgenology (1976), 2021-12, Vol.217 (6), p.1299-1311</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c291t-3d4d4e429200f5e9cc411adce55ddb634e5ab32c53fc7c96fff1f05a83af1c323</citedby><cites>FETCH-LOGICAL-c291t-3d4d4e429200f5e9cc411adce55ddb634e5ab32c53fc7c96fff1f05a83af1c323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4120,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34008998$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Su-Ju</creatorcontrib><creatorcontrib>Wahab, Rifat A</creatorcontrib><creatorcontrib>Sobel, Lawrence D</creatorcontrib><creatorcontrib>Zhang, Bin</creatorcontrib><creatorcontrib>Brown, Ann L</creatorcontrib><creatorcontrib>Lewis, Kyle</creatorcontrib><creatorcontrib>Vijapura, Charmi</creatorcontrib><creatorcontrib>Mahoney, Mary C</creatorcontrib><title>Analysis of 612 Benign Papillomas Diagnosed At Core Biopsy: Rate of Upgrade to Malignancy, Factors Associated with Upgrade, and A Proposal For Selective Surgical Excision</title><title>American journal of roentgenology (1976)</title><addtitle>AJR Am J Roentgenol</addtitle><description>Despite numerous published studies, management of benign papillomas without atypia remains controversial.
To determine the malignancy upgrade rate of benign papillomas, identify risk factors for upgrade, and formulate criteria for selective surgery.
This retrospective study included benign papillomas without atypia diagnosed on percutaneous biopsy between 12/01/2000 and 12/31/2019. Papillomas that did not undergo surgical excision or at least 2 years of imaging and/or clinical follow-up were excluded. Clinical, imaging, and histopathologic features were extracted from the electronic medical record. Features associated with upgrade to malignancy were identified. Multivariable logistic regression was performed.
The study included 612 benign papillomas in 543 women (mean age 54.5 ± 12.1 years); 466 papillomas were excised, and 146 underwent imaging/clinical surveillance. The upgrade rate to malignancy was 2.3% (14/612). Upgrade rate was associated (p<.05) with radiology-pathology correlation (50.0% if discordant vs 2.1% if concordant), patient age (5.6% for age ≥60 vs 0.7% for age <60), presenting symptoms (6.7% if palpable mass or pathologic nipple discharge vs 1.3% if no symptoms), and lesion size (7.3% if ≥10 mm vs 0.6% if <10 mm). Three of 14 upgraded papillomas were associated with ≥4 metachronous or concurrent peripheral papillomas. No incidental papilloma or papilloma reported as completely excised on core biopsy histopathologic analysis was upgraded. A predictive model combining radiology-pathology discordance, symptoms (palpable mass or nipple discharge), age ≥60, size ≥10 mm, and presence of ≥4 metachronous or concurrent peripheral papillomas achieved AUC 0.91, sensitivity 79%, and specificity 89% for upgrade. Selective surgery based on presence of any of these five factors, while excluding from surgery incidental papillomas and papillomas reported as completely excised on histopathology, would spare 294 of 612 lesions from routine excision, while identifying all 14 upgraded lesions.
Benign non-atypical papillomas have a low malignancy upgrade rate; routine surgical excision may not be necessary. Selective excision is recommended for lesions satisfying any of the 5 criteria. Incidental papillomas or papillomas completely excised on histopathology may undergo imaging follow-up.
The proposed criteria for selective surgery of benign papillomas on core biopsy would reduce surgeries without delaying diagnosis of malignancy.</description><issn>0361-803X</issn><issn>1546-3141</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNo9kUtvEzEURi0EoqGwY43ukkUm-DkZs5uGhoeKqFoqsRvd-BGMnPHUnkDzl_ormdKW1ZWuznc2h5DXjC44Z_Jd--ViwdmCq0bwJ2TGlKwrwSR7SmZU1KxqqPhxRF6U8otSumz08jk5EpLSRutmRm7bHuOhhALJQ804nLg-bHs4xyHEmHZY4EPAbZ-Ks9COsErZwUlIQzm8hwsc3d3uathmtA7GBF8xTnPszWEOazRjygXaUpIJE2vhTxh_PuJzwH5ywnlOQyoYYZ0yXLrozBh-O7jc520w0_v0xoQSUv-SPPMYi3v1cI_J1fr0--pTdfbt4-dVe1YZrtlYCSutdJJrTqlXThsjGUNrnFLWbmohncKN4EYJb5ZG19575qnCRqBnRnBxTN7ee4ecrveujN0uFONixN6lfem44o2mjdT1hM7vUZNTKdn5bshhh_nQMdrd1emmOh1n3b86E_7mwbzf7Jz9Dz_mEH8BhxqL4Q</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Lee, Su-Ju</creator><creator>Wahab, Rifat A</creator><creator>Sobel, Lawrence D</creator><creator>Zhang, Bin</creator><creator>Brown, Ann L</creator><creator>Lewis, Kyle</creator><creator>Vijapura, Charmi</creator><creator>Mahoney, Mary C</creator><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20211201</creationdate><title>Analysis of 612 Benign Papillomas Diagnosed At Core Biopsy: Rate of Upgrade to Malignancy, Factors Associated with Upgrade, and A Proposal For Selective Surgical Excision</title><author>Lee, Su-Ju ; Wahab, Rifat A ; Sobel, Lawrence D ; Zhang, Bin ; Brown, Ann L ; Lewis, Kyle ; Vijapura, Charmi ; Mahoney, Mary C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c291t-3d4d4e429200f5e9cc411adce55ddb634e5ab32c53fc7c96fff1f05a83af1c323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Su-Ju</creatorcontrib><creatorcontrib>Wahab, Rifat A</creatorcontrib><creatorcontrib>Sobel, Lawrence D</creatorcontrib><creatorcontrib>Zhang, Bin</creatorcontrib><creatorcontrib>Brown, Ann L</creatorcontrib><creatorcontrib>Lewis, Kyle</creatorcontrib><creatorcontrib>Vijapura, Charmi</creatorcontrib><creatorcontrib>Mahoney, Mary C</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of roentgenology (1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Su-Ju</au><au>Wahab, Rifat A</au><au>Sobel, Lawrence D</au><au>Zhang, Bin</au><au>Brown, Ann L</au><au>Lewis, Kyle</au><au>Vijapura, Charmi</au><au>Mahoney, Mary C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Analysis of 612 Benign Papillomas Diagnosed At Core Biopsy: Rate of Upgrade to Malignancy, Factors Associated with Upgrade, and A Proposal For Selective Surgical Excision</atitle><jtitle>American journal of roentgenology (1976)</jtitle><addtitle>AJR Am J Roentgenol</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>217</volume><issue>6</issue><spage>1299</spage><epage>1311</epage><pages>1299-1311</pages><issn>0361-803X</issn><eissn>1546-3141</eissn><abstract>Despite numerous published studies, management of benign papillomas without atypia remains controversial.
To determine the malignancy upgrade rate of benign papillomas, identify risk factors for upgrade, and formulate criteria for selective surgery.
This retrospective study included benign papillomas without atypia diagnosed on percutaneous biopsy between 12/01/2000 and 12/31/2019. Papillomas that did not undergo surgical excision or at least 2 years of imaging and/or clinical follow-up were excluded. Clinical, imaging, and histopathologic features were extracted from the electronic medical record. Features associated with upgrade to malignancy were identified. Multivariable logistic regression was performed.
The study included 612 benign papillomas in 543 women (mean age 54.5 ± 12.1 years); 466 papillomas were excised, and 146 underwent imaging/clinical surveillance. The upgrade rate to malignancy was 2.3% (14/612). Upgrade rate was associated (p<.05) with radiology-pathology correlation (50.0% if discordant vs 2.1% if concordant), patient age (5.6% for age ≥60 vs 0.7% for age <60), presenting symptoms (6.7% if palpable mass or pathologic nipple discharge vs 1.3% if no symptoms), and lesion size (7.3% if ≥10 mm vs 0.6% if <10 mm). Three of 14 upgraded papillomas were associated with ≥4 metachronous or concurrent peripheral papillomas. No incidental papilloma or papilloma reported as completely excised on core biopsy histopathologic analysis was upgraded. A predictive model combining radiology-pathology discordance, symptoms (palpable mass or nipple discharge), age ≥60, size ≥10 mm, and presence of ≥4 metachronous or concurrent peripheral papillomas achieved AUC 0.91, sensitivity 79%, and specificity 89% for upgrade. Selective surgery based on presence of any of these five factors, while excluding from surgery incidental papillomas and papillomas reported as completely excised on histopathology, would spare 294 of 612 lesions from routine excision, while identifying all 14 upgraded lesions.
Benign non-atypical papillomas have a low malignancy upgrade rate; routine surgical excision may not be necessary. Selective excision is recommended for lesions satisfying any of the 5 criteria. Incidental papillomas or papillomas completely excised on histopathology may undergo imaging follow-up.
The proposed criteria for selective surgery of benign papillomas on core biopsy would reduce surgeries without delaying diagnosis of malignancy.</abstract><cop>United States</cop><pmid>34008998</pmid><doi>10.2214/AJR.21.25832</doi><tpages>13</tpages></addata></record> |
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| title | Analysis of 612 Benign Papillomas Diagnosed At Core Biopsy: Rate of Upgrade to Malignancy, Factors Associated with Upgrade, and A Proposal For Selective Surgical Excision |
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