Benign breast papillary lesions diagnosed on core biopsy: upgrade rate and risk factors associated with malignancy on surgical excision

Evaluation of radiologically detected breast lesions is a common task in surgical pathology. Some benign lesions on biopsy are associated with an upgradeto in situ or invasive carcinoma on excision. The non-atypical breast papillomahas published upgraderates of 0 to 29%. Traditionally, papillomashave been managed surgically, but the wide range of upgraderates has raised uncertainty about the need for routine surgical excision. This study aims to identify risk factors associated with upgradeand determine the upgraderate of non-atypical papillomasat our institution. In a retrospective review of pathology reports, we identified 266 patients with a diagnosis of benign papillomaon breast core biopsy. One hundred eighty-two patients underwent surgical resection. The final surgical pathologyreports of all patients were reviewed and divided into one of two groups—benign or malignant. Twenty-one patients had a final diagnosis of in situ or invasive carcinoma, resulting in an upgraderate of 12%. Radiologically detected lesions with calcifications were at higher risk for upgrade(OR = 4.45, 95% CI 1.08–18.27) than lesions without calcifications. Additionally, advanced patient age (OR = 1.07, 95% CI 1.03–1.13) and lesion size greater than 0.5 cm (OR = 2.59, 95% CI 0.38–17.48) was associated with upgradeto malignancy. Routine surgical excision of all papillomasis not recommended. Younger patients without high-risk features may benefit from clinical and radiologic follow-up alone. Accurate risk stratification will spare low-risk women unnecessary surgery.