Soo Kyung Ahn1, Wonshik Han2, Hyeong-Gon Moon2, Min Kyoon Kim3, Dong-Young Noh2, Bong-Wha Jung4, Sung-Won Kim5, Eunyoung Ko6. 1. Breast & Endocrine Cancer Center, Dept of Surgery, Kangnam Sacred Heart Hospital, Hallym University, 91, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, South Korea. Electronic address: Sooahn79@gmail.com. 2. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea. 3. Department of Surgery, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea. 4. Breast & Endocrine Cancer Center, Dept of Surgery, Kangnam Sacred Heart Hospital, Hallym University, 91, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, South Korea. 5. Department of Surgery, Daerim St. Mary's Hospital, 657, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, South Korea. 6. Breast Surgery, Oncology Center, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates. Electronic address: koeun02@gmail.com.
Abstract
BACKGROUND: The management of benign intraductal papilloma diagnosed on core needle biopsy (CNB) remains unclear. This study was designed to evaluate factors predicting malignancy in patients diagnosed with benign papilloma without atypia at ultrasound-guided CNB and to develop a scoring system predicting malignancy based on clinical, radiological and pathological factors on further excisional biopsy. METHODS: The study enrolled patients diagnosed with benign papillomas (including benign and atypical papillary lesions) at CNB. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy. RESULTS: A total of 520 CNBs were diagnosed with benign or atypical papilloma. Of these, 452 were benign papilloma without atypia. Of the 250 lesions subsequently excised surgically from 234 women, 17 (6.8%) were diagnosed with malignancy. Multivariate analysis revealed that bloody nipple discharge, size on imaging ≥15 mm, BI-RADS≥4b, peripheral location and palpability were independent predictors of malignancy. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.947 (95% CI: 0.913-0.981, p < 0.001) and a negative predictive value was 100%. In a validation set of 62 patients, an area under the ROC curve was 0.926 (95% CI: 0.857-0.995, p < 0.001). CONCLUSIONS: A scoring system predicting malignancy in patients diagnosed by CNB with benign papilloma without atypia was developed. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate.
BACKGROUND: The management of benign intraductal papilloma diagnosed on core needle biopsy (CNB) remains unclear. This study was designed to evaluate factors predicting malignancy in patients diagnosed with benign papilloma without atypia at ultrasound-guided CNB and to develop a scoring system predicting malignancy based on clinical, radiological and pathological factors on further excisional biopsy. METHODS: The study enrolled patients diagnosed with benign papillomas (including benign and atypical papillary lesions) at CNB. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy. RESULTS: A total of 520 CNBs were diagnosed with benign or atypical papilloma. Of these, 452 were benign papilloma without atypia. Of the 250 lesions subsequently excised surgically from 234 women, 17 (6.8%) were diagnosed with malignancy. Multivariate analysis revealed that bloody nipple discharge, size on imaging ≥15 mm, BI-RADS≥4b, peripheral location and palpability were independent predictors of malignancy. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.947 (95% CI: 0.913-0.981, p < 0.001) and a negative predictive value was 100%. In a validation set of 62 patients, an area under the ROC curve was 0.926 (95% CI: 0.857-0.995, p < 0.001). CONCLUSIONS: A scoring system predicting malignancy in patients diagnosed by CNB with benign papilloma without atypia was developed. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate.
Authors: Sayee Kiran; Young Ju Jeong; Maria E Nelson; Alexander Ring; Meade B Johnson; Pulin A Sheth; Yanling Ma; Stephen F Sener; Julie E Lang Journal: J Surg Res Date: 2018-06-29 Impact factor: 2.192
Authors: Christoph J Rageth; Elizabeth A M O'Flynn; Katja Pinker; Rahel A Kubik-Huch; Alexander Mundinger; Thomas Decker; Christoph Tausch; Florian Dammann; Pascal A Baltzer; Eva Maria Fallenberg; Maria P Foschini; Sophie Dellas; Michael Knauer; Caroline Malhaire; Martin Sonnenschein; Andreas Boos; Elisabeth Morris; Zsuzsanna Varga Journal: Breast Cancer Res Treat Date: 2018-11-30 Impact factor: 4.872
Authors: Ian G Campbell; Kylie L Gorringe; Tanjina Kader; Kenneth Elder; Magnus Zethoven; Timothy Semple; Prue Hill; David L Goode; Niko Thio; Dane Cheasley; Simone M Rowley; David J Byrne; Jia-Min Pang; Islam M Miligy; Andrew R Green; Emad A Rakha; Stephen B Fox; G Bruce Mann Journal: NPJ Breast Cancer Date: 2020-03-12