JOURNAL OF MEDICAL AND SURGICAL RESEARCH - Vol. Xl, n 2, December 2024
Pages: 1358-1367
Print Article
Download XML Download PDF
Factors Associated with Surgical Excision in Patients with Papillary Breast Lesions: A 20-Year Single-Center Experience in South Korea
Author: Chang-Hyun Shin, Shijin Cho, Huieun Ju, Jae Pak Yi, Su Hyun Lim, Hyobin Kim, Hoon Choi, Se Jeong Oh, Young-Joon Kang
Category: JMSR Oncology
Abstract:
Background: Patients with incidental benign solitary papilloma of the breast with imaging concordance may be offered follow-up treatment. Recently, as vacuum-assisted breast biopsy (VAB) has become more common, it is increasingly being used as an alternative to core needle biopsy for initial biopsy. This study investigated the factors that necessitate surgical excision after initial needle biopsy of papillary breast lesions. Methods: A retrospective review was conducted of patients diagnosed with papilloma or papillary findings in pathology reports at a single institution between 2001 and 2020. Logistic regression and Cox proportional hazards models were used to analyze the factors associated with surgical excision and papilloma recurrence. Results: Among the 266 patients reviewed, the malignancy upgrade rate was 6.7%, with significantly higher rates in lesions with atypia (p<0.001). Factors associated with the need for surgical excision after initial needle biopsy included older age (odds ratio [OR] =1.064; p=0.015), larger tumor size (OR=3.015; p=0.003), and absence of intraductal lesions (OR=0.049; p<0.001). Additionally, a higher body mass index (BMI) was associated with the recurrence of benign papillary lesions (OR=1.156; p=0.045), and patients with a BMI below 25 showed a significantly lower recurrence rate. Conclusion: Older age, absence of intraductal lesions, and larger tumor size were associated with the likelihood of requiring surgical excision following needle biopsy. These findings suggest that VAB or vacuum-assisted excision should be considered in younger women with smaller intraductal lesions. Additionally, higher BMI was found to be significantly associated with the recurrence of benign papillomas.
Keywords: Breast neoplasm, Papilloma, intraductal, Breast disease, Biopsy, needle, Operative Surgical Procedures
References:
1. Wei S: Papillary Lesions of the Breast: An Update. Arch Pathol Lab Med 2016, 140:628-43.
2. Lewis JT, Hartmann LC, Vierkant RA, Maloney SD, Shane Pankratz V, Allers TM, Frost MH, Visscher DW: An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol 2006, 30:665-72.
3. Valdes EK, Feldman SM, Boolbol SK: Papillary lesions: a review of the literature. Ann Surg Oncol 2007, 14:1009-13.
4. Wen X, Cheng W: Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol 2013, 20:94-101.
5. Sydnor MK, Wilson JD, Hijaz TA, Massey HD, Shaw de Paredes ES: Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy. Radiology 2007, 242:58-62.
6. Sohn V, Keylock J, Arthurs Z, Wilson A, Herbert G, Perry J, Eckert M, Smith D, Groo S, Brown T: Breast papillomas in the era of percutaneous needle biopsy. Ann Surg Oncol 2007, 14:2979-84.
7. Mercado CL, Hamele-Bena D, Oken SM, Singer CI, Cangiarella J: Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology 2006, 238:801-8.
8. Jaffer S, Bleiweiss IJ, Nagi C: Incidental intraductal papillomas (<2 mm) of the breast diagnosed on needle core biopsy do not need to be excised. Breast J 2013, 19:130-3.
9. Park HL, Hong J: Vacuum-assisted breast biopsy for breast cancer. Gland Surg 2014, 3:120-7.
10. Cullinane C, Byrne J, Kelly L, M OS, Antony Corrigan M, Paul Redmond H: The positive predictive value of vacuum assisted biopsy (VAB) in predicting final histological diagnosis for breast lesions of uncertain malignancy (B3 lesions): A systematic review & meta-analysis. Eur J Surg Oncol 2022, 48:1464-74.
11. Nakhlis F, Baker GM, Pilewskie M, Gelman R, Calvillo KZ, Ludwig K, McAuliffe PF, Willey S, Rosenberger LH, Parker C, Gallagher K, Jacobs L, Feldman S, Lange P, DeSantis SD, Schnitt SJ, King TA: The Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In Situ in Patients with Intraductal Papilloma without Atypia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 034). Ann Surg Oncol 2021, 28:2573-8.
12. Bennett IC, Saboo A: The Evolving Role of Vacuum Assisted Biopsy of the Breast: A Progression from Fine-Needle Aspiration Biopsy. World J Surg 2019, 43:1054-61.
13. Kong Y, Lyu N, Wang J, Wang Y, Sun Y, Xie Z, Liu P: Does Mammotome biopsy affect surgery option and margin status of breast conserving surgery in breast cancer? Gland Surg 2021, 10:2428-37.
14. Yihong Wang ECS: Papillary neoplasm of the breast – A review and update. Human Pathology Reports 2021, 26.
15. Jacobs TW, Connolly JL, Schnitt SJ: Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? Am J Surg Pathol 2002, 26:1095-110.
16. Castells X, Domingo L, Corominas JM, Tora-Rocamora I, Quintana MJ, Bare M, Vidal C, Natal C, Sanchez M, Saladie F, Ferrer J, Vernet M, Servitja S, Rodriguez-Arana A, Roman M, Espinas JA, Sala M: Breast cancer risk after diagnosis by screening mammography of nonproliferative or proliferative benign breast disease: a study from a population-based screening program. Breast Cancer Res Treat 2015, 149:237-44.
17. Shouhed D, Amersi FF, Spurrier R, Dang C, Astvatsaturyan K, Bose S, Phillips E: Intraductal papillary lesions of the breast: clinical and pathological correlation. Am Surg 2012, 78:1161-5.
18. American Society of Breast Surgeons. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic: Executive Summary. Available at https://www.breastsurgeons.org/docs/news/The_COVID-19_Pandemic_Breast_Cancer_Consortium_Recommendations_EXECUTIVE_SUMMARY.pdf. Accessed August 10, 2020.
19. Johansson A, Christakou AE, Iftimi A, Eriksson M, Tapia J, Skoog L, Benz CC, Rodriguez-Wallberg KA, Hall P, Czene K, Lindstrom LS: Characterization of Benign Breast Diseases and Association With Age, Hormonal Factors, and Family History of Breast Cancer Among Women in Sweden. JAMA Netw Open 2021, 4:e2114716.
|