Asymptomatic Benign Papilloma Without Atypia Diagnosed at Ultrasonography-Guided 14-Gauge Core Needle Biopsy: Which Subgroup can be Managed by Observation?

BACKGROUND: For asymptomatic benign papillomas detected at ultrasonography-guided 14-gauge core-needle biopsy (US-CNB), the decision to perform excision versus observation has been a topic of debate. We sought to determine which subgroup of asymptomatic benign papillomas without atypia diagnosed at US-CNB can be safely managed by observation versus immediate excision. MATERIALS: Overall, 230 asymptomatic benign papillomas in 197 women (mean age 46.6 ± 9.5 years; range 22-78), diagnosed at US-CNB using immunohistochemistry staining when needed and then managed by surgery (n = 144) or vacuum-assisted excision (VAE) with at least 12 months of follow-up after benign VAE results (n = 86) were included in this study. The upgrade rate to malignancy was calculated. Clinical and radiological variables, including age, size, Breast Image Reporting and Data System (BI-RADS) category, and imaging-pathology correlation were evaluated to find associations with malignancy using multivariate analysis.
RESULTS: The upgrade rate to malignancy was 2.6 % (6 of 230): four were ductal carcinomas in situ and two were 1.5- and 9-mm-sized invasive ductal carcinomas without lymph node metastasis. The upgrade rates of papillomas with a BI-RADS category 3-4a and imaging-pathology concordance were 1.4 and 1.8 %, respectively. Category 4b-5 and imaging-pathology discordance were independently associated with malignancy, with upgrade rates of 13 and 50 %, respectively. Age and lesion size were not associated with malignancy.
CONCLUSION: Asymptomatic benign papillomas with probable benign or low suspicious US features or imaging-pathology concordance can be followed-up as opposed to immediate excision.