Learning objectives
-Toreview the variety of papillary lesions of the breast
-To describe the most relevant radiologic aspects of papillary lesions in mammography, ultrasonography andmagnetic resonance imaging.
-To illustrate the relationship between the imaging and pathologic findings of the different histologic variations of papillary lesions of the breast (PLB).
Background
PLB comprises a wide spectrum of lesions. Histologically they are divided as papillomas that are benign neoplasm of the breast which can be solitary or multiple, papillomas with atypia, papillomas with DCIS and solid papillary carcinoma. The management of papilloma remains controversial. It is essential that radiologists know the suspicious findings that might be related to malignancy and the World Health Organization (WHO) histologic classification, where several sub-types of papillomas are described.
Findings and procedure details
PLB represent less that 3% of the solid lesions of the breast. They are arborescent proliferations of the ductal epithelium that have a fibrovascular pedicle. They develop in the lumen of the walls of the ductal system, from the nipple to the most peripheral lobular-ductal terminal (ULDT).
The diagnostic of PLB is challenging, there are certain characteristics that differentiates them nevertheless in some cases radiological findings with different imaging techniques do not distinguish between benign and malignant lesions. It is classified as a high-risk lesion...
Conclusion
PLB, despite being a benign neoplasm on imaging it is an entity that requires a histopathological diagnosis with core needle biopsy or vacuum assisted biopsy and should always be classified as a suspicious finding, BI-RADS 4 or even 5 considering its features. The management of these lesions on whether to perform excision or follow-up is still a matter of discussion.
Personal information and conflict of interest
A. V. Altamirano S.; Masaya/NI - nothing to disclose C. C. Zamora G.; Managua/NI - nothing to disclose N. Martinez Chavez; Managua/NI - nothing to disclose E. F. Altamirano Carcache; Masaya/NI - nothing to disclose R. A. Acevedo; Managua/NI - nothing to disclose Y. P. Medrano; Managua/NI - nothing to disclose
References
1- Holley SO, et al. Pathologic outcomes of nonmalignant papillary breast lesions diagnosed at imaging-guided core needle biopsy.Radiology.2012 Nov;265(2):379-84.
2- Tran HT, Mursleen A, Mirpour S, Ghanem O, Farha MJ. Papillary Breast Lesions: Association with Malignancy and Upgrade Rates on Surgical Excision.Am Surg.2017 Nov 01;83(11):1294-1297.
3-Han SH, et al. Benign Intraductal Papilloma without Atypia on Core Needle Biopsy Has a Low Rate of Upgrading to Malignancy after Excision.J Breast Cancer.2018 Mar;21(1):80-86
4-Kiran S et al. Are we overtreating intraductal papillomas?J. Surg. Res.2018 Nov;231:387-394.
5- WHO...