Multidisciplinary Review of Intraductal Papilloma of the Breast can Identify Patients who may Omit Surgical Excision
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 201...
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| Veröffentlicht in: | Annals of surgical oncology 2021-10, Vol.28 (10), p.5768-5774 |
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| container_title | Annals of surgical oncology |
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| creator | Abbassi-Rahbar, Shahrzad Sack, Stephen Larson, Kelsey E. Wagner, Jamie L. Kilgore, Lyndsey J. Balanoff, Christa R. Winblad, Onalisa D. Amin, Amanda L. |
| description | 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% 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. |
| doi_str_mv | 10.1245/s10434-021-10520-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2557533188</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2557533188</sourcerecordid><originalsourceid>FETCH-LOGICAL-c352t-540cb5c237bc69db49306ba5b3e74ecc93394c1dad6ff1cc0a49dca7285c30313</originalsourceid><addsrcrecordid>eNp9kUtLAzEQxxdRsFa_gKeAFy-ree7jqKVqoVLxcQ7Z2Wybso-aZK399qauIHjwNMPMb_7MzD-Kzgm-IpSLa0cwZzzGlMQEC4pjchCNiAglnmTkMOQ4yeKcJuI4OnFujTFJGRajyD_2tTelcWA2tWmV3aFn_WH0FnUVmrXeqrIHr2r0pDamrrtG7Rt-pdGt1cp5BKpFs1K33lS7AHkTUoe2qw41aocWjfHopbdLA0Fj-gnGma49jY4qVTt99hPH0dvd9HXyEM8X97PJzTwGJqiPBcdQCKAsLSDJy4LnDCeFEgXTKdcAOWM5B1KqMqkqAoAVz0tQKc0EMMwIG0eXg-7Gdu-9dl424VBd16rVXe8kFSIVjJEsC-jFH3Td9bYN2wUqyQmhGWaBogMFtnPO6kpurGnC0yTBcm-EHIyQwQj5bYTcb8GGIRfgdqntr_Q_U19OHIxH</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2569112803</pqid></control><display><type>article</type><title>Multidisciplinary Review of Intraductal Papilloma of the Breast can Identify Patients who may Omit Surgical Excision</title><source>SpringerLink Journals - AutoHoldings</source><creator>Abbassi-Rahbar, Shahrzad ; Sack, Stephen ; Larson, Kelsey E. ; Wagner, Jamie L. ; Kilgore, Lyndsey J. ; Balanoff, Christa R. ; Winblad, Onalisa D. ; Amin, Amanda L.</creator><creatorcontrib>Abbassi-Rahbar, Shahrzad ; Sack, Stephen ; Larson, Kelsey E. ; Wagner, Jamie L. ; Kilgore, Lyndsey J. ; Balanoff, Christa R. ; Winblad, Onalisa D. ; Amin, Amanda L.</creatorcontrib><description>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.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-021-10520-1</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Biopsy ; Breast cancer ; Breast Oncology ; Invasiveness ; Malignancy ; Medicine ; Medicine & Public Health ; Oncology ; Papilloma ; Patients ; Risk groups ; Surgery ; Surgical Oncology ; Tumors</subject><ispartof>Annals of surgical oncology, 2021-10, Vol.28 (10), p.5768-5774</ispartof><rights>This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2021</rights><rights>This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-540cb5c237bc69db49306ba5b3e74ecc93394c1dad6ff1cc0a49dca7285c30313</citedby><cites>FETCH-LOGICAL-c352t-540cb5c237bc69db49306ba5b3e74ecc93394c1dad6ff1cc0a49dca7285c30313</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-021-10520-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-021-10520-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids></links><search><creatorcontrib>Abbassi-Rahbar, Shahrzad</creatorcontrib><creatorcontrib>Sack, Stephen</creatorcontrib><creatorcontrib>Larson, Kelsey E.</creatorcontrib><creatorcontrib>Wagner, Jamie L.</creatorcontrib><creatorcontrib>Kilgore, Lyndsey J.</creatorcontrib><creatorcontrib>Balanoff, Christa R.</creatorcontrib><creatorcontrib>Winblad, Onalisa D.</creatorcontrib><creatorcontrib>Amin, Amanda L.</creatorcontrib><title>Multidisciplinary Review of Intraductal Papilloma of the Breast can Identify Patients who may Omit Surgical Excision</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><description>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.</description><subject>Biopsy</subject><subject>Breast cancer</subject><subject>Breast Oncology</subject><subject>Invasiveness</subject><subject>Malignancy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oncology</subject><subject>Papilloma</subject><subject>Patients</subject><subject>Risk groups</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Tumors</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kUtLAzEQxxdRsFa_gKeAFy-ree7jqKVqoVLxcQ7Z2Wybso-aZK399qauIHjwNMPMb_7MzD-Kzgm-IpSLa0cwZzzGlMQEC4pjchCNiAglnmTkMOQ4yeKcJuI4OnFujTFJGRajyD_2tTelcWA2tWmV3aFn_WH0FnUVmrXeqrIHr2r0pDamrrtG7Rt-pdGt1cp5BKpFs1K33lS7AHkTUoe2qw41aocWjfHopbdLA0Fj-gnGma49jY4qVTt99hPH0dvd9HXyEM8X97PJzTwGJqiPBcdQCKAsLSDJy4LnDCeFEgXTKdcAOWM5B1KqMqkqAoAVz0tQKc0EMMwIG0eXg-7Gdu-9dl424VBd16rVXe8kFSIVjJEsC-jFH3Td9bYN2wUqyQmhGWaBogMFtnPO6kpurGnC0yTBcm-EHIyQwQj5bYTcb8GGIRfgdqntr_Q_U19OHIxH</recordid><startdate>20211001</startdate><enddate>20211001</enddate><creator>Abbassi-Rahbar, Shahrzad</creator><creator>Sack, Stephen</creator><creator>Larson, Kelsey E.</creator><creator>Wagner, Jamie L.</creator><creator>Kilgore, Lyndsey J.</creator><creator>Balanoff, Christa R.</creator><creator>Winblad, Onalisa D.</creator><creator>Amin, Amanda L.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20211001</creationdate><title>Multidisciplinary Review of Intraductal Papilloma of the Breast can Identify Patients who may Omit Surgical Excision</title><author>Abbassi-Rahbar, Shahrzad ; Sack, Stephen ; Larson, Kelsey E. ; Wagner, Jamie L. ; Kilgore, Lyndsey J. ; Balanoff, Christa R. ; Winblad, Onalisa D. ; Amin, Amanda L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-540cb5c237bc69db49306ba5b3e74ecc93394c1dad6ff1cc0a49dca7285c30313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Biopsy</topic><topic>Breast cancer</topic><topic>Breast Oncology</topic><topic>Invasiveness</topic><topic>Malignancy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Oncology</topic><topic>Papilloma</topic><topic>Patients</topic><topic>Risk groups</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abbassi-Rahbar, Shahrzad</creatorcontrib><creatorcontrib>Sack, Stephen</creatorcontrib><creatorcontrib>Larson, Kelsey E.</creatorcontrib><creatorcontrib>Wagner, Jamie L.</creatorcontrib><creatorcontrib>Kilgore, Lyndsey J.</creatorcontrib><creatorcontrib>Balanoff, Christa R.</creatorcontrib><creatorcontrib>Winblad, Onalisa D.</creatorcontrib><creatorcontrib>Amin, Amanda L.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abbassi-Rahbar, Shahrzad</au><au>Sack, Stephen</au><au>Larson, Kelsey E.</au><au>Wagner, Jamie L.</au><au>Kilgore, Lyndsey J.</au><au>Balanoff, Christa R.</au><au>Winblad, Onalisa D.</au><au>Amin, Amanda L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multidisciplinary Review of Intraductal Papilloma of the Breast can Identify Patients who may Omit Surgical Excision</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><date>2021-10-01</date><risdate>2021</risdate><volume>28</volume><issue>10</issue><spage>5768</spage><epage>5774</epage><pages>5768-5774</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><doi>10.1245/s10434-021-10520-1</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2021-10, Vol.28 (10), p.5768-5774 |
| issn | 1068-9265 1534-4681 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2557533188 |
| source | SpringerLink Journals - AutoHoldings |
| subjects | Biopsy Breast cancer Breast Oncology Invasiveness Malignancy Medicine Medicine & Public Health Oncology Papilloma Patients Risk groups Surgery Surgical Oncology Tumors |
| title | Multidisciplinary Review of Intraductal Papilloma of the Breast can Identify Patients who may Omit Surgical Excision |
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