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Atypical Papilloma
Lori Strachowski, MD; Cecilia L. Mercado, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Papilloma with atypia; atypical papillary lesion
            • Definitions

              • Papilloma or papillary lesion with
                • Associated atypical ductal hyperplasia (ADH) within or adjacent
                • Or associated monomorphic proliferation which would otherwise meet criteria for low-grade DCIS but < 3 mm in size
                • Cellular atypia in a papilloma can be seen but no longer = atypical papilloma

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Image-Guided Biopsy

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    Selected References

                                    1. Falomo E et al: Variability in the management recommendations given for high-risk breast lesions detected on image-guided core needle biopsy at U.S. academic institutions. Curr Probl Diagn Radiol. ePub, 2018
                                    2. Khan S et al: Papillary lesions of the breast: To excise or observe? Breast J. 24(3):350-355, 2018
                                    3. Kiran S et al: Are we overtreating intraductal papillomas? J Surg Res. 231:387-394, 2018
                                    4. Lamb LR et al: Pathologic upgrade rates of high-risk breast lesions on digital two-dimensional vs tomosynthesis mammography. J Am Coll Surg. 226(5):858-867, 2018
                                    5. Symbol B et al: Management of intraductal papilloma without atypia of the breast diagnosed on core biopsy: Size and sampling matter. Breast J. 24(5):738-742, 2018
                                    6. Ahn SK et al: Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: Scoring system for predicting malignancy. Eur J Surg Oncol. ePub, 2017
                                    7. Rageth CJ et al: First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 159(2):203-13, 2016
                                    8. Yang Y et al: The significance of combined CK5/6 and p63 immunohistochemistry in predicting the risks of subsequent carcinoma development in intraductal papilloma of the breast. Pathol Int. 65(2):81-8, 2015
                                    9. Wen X et al: Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol. 20(1):94-101, 2013
                                    10. Brennan SB et al: Papilloma diagnosed at MRI-guided vacuum-assisted breast biopsy: is surgical excision still warranted? AJR Am J Roentgenol. 199(4):W512-9, 2012
                                    11. Fu CY et al: Papillary breast lesions diagnosed by core biopsy require complete excision. Eur J Surg Oncol. 38(11):1029-35, 2012
                                    12. Zhu Y et al: Solitary intraductal papillomas of the breast: MRI features and differentiation from small invasive ductal carcinomas. AJR Am J Roentgenol. 199(4):936-42, 2012
                                    13. Chang JM et al: Papillary lesions initially diagnosed at ultrasound-guided vacuum-assisted breast biopsy: rate of malignancy based on subsequent surgical excision. Ann Surg Oncol. 18(9):2506-14, 2011
                                    14. Kim MJ et al: The diagnosis of non-malignant papillary lesions of the breast: comparison of ultrasound-guided automated gun biopsy and vacuum-assisted removal. Clin Radiol. 66(6):530-5, 2011
                                    15. Jung SY et al: Risk factors for malignancy in benign papillomas of the breast on core needle biopsy. World J Surg. 34(2):261-5, 2010
                                    16. Youk JH et al: Atypical papilloma diagnosed by sonographically guided 14-gauge core needle biopsy of breast mass. AJR Am J Roentgenol. 194(5):1397-402, 2010
                                    17. Bode MK et al: Ultrasonography-guided core needle biopsy in differential diagnosis of papillary breast tumors. Acta Radiol. 50(7):722-9, 2009
                                    18. Cheng TY et al: Risk factors associated with conversion from nonmalignant to malignant diagnosis after surgical excision of breast papillary lesions. Ann Surg Oncol. 16(12):3375-9, 2009
                                    19. Tseng HS et al: The management of papillary lesion of the breast by core needle biopsy. Eur J Surg Oncol. 35(1):21-4, 2009
                                    20. Ueng SH et al: Papillary neoplasms of the breast: a review. Arch Pathol Lab Med. 133(6):893-907, 2009
                                    21. Kil WH et al: Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy? Breast. 17(3):258-62, 2008
                                    22. Shin HJ et al: Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy: comparison of sonographic features and biopsy methods. AJR Am J Roentgenol. 190(3):630-6, 2008
                                    23. Ko ES et al: Sonographically-guided 14-gauge core needle biopsy for papillary lesions of the breast. Korean J Radiol. 8(3):206-11, 2007
                                    24. Lewis JT et al: An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol. 30:665-72, 2006
                                    25. Liberman L et al: Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR Am J Roentgenol. 186(5):1328-34, 2006
                                    26. Mercado CL et al: Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology. 238(3):801-8, 2006
                                    27. Mercado CL et al: Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy. Radiology. 221(3):650-5, 2001
                                    28. Orel SG et al: MR imaging in patients with nipple discharge: initial experience. Radiology. 216(1):248-54, 2000
                                    29. Hild F et al: Ductal orientated sonography improves the diagnosis of pathological nipple discharge of the female breast compared with galactography. Eur J Cancer Prev. 7 Suppl 1:S57-62, 1998
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Pathology

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Synonyms

                                                • Papilloma with atypia; atypical papillary lesion
                                              • Definitions

                                                • Papilloma or papillary lesion with
                                                  • Associated atypical ductal hyperplasia (ADH) within or adjacent
                                                  • Or associated monomorphic proliferation which would otherwise meet criteria for low-grade DCIS but < 3 mm in size
                                                  • Cellular atypia in a papilloma can be seen but no longer = atypical papilloma

                                              IMAGING

                                              • General Features

                                                • Mammographic Findings

                                                  • Ultrasonographic Findings

                                                    • MR Findings

                                                      • Image-Guided Biopsy

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      Selected References

                                                                      1. Falomo E et al: Variability in the management recommendations given for high-risk breast lesions detected on image-guided core needle biopsy at U.S. academic institutions. Curr Probl Diagn Radiol. ePub, 2018
                                                                      2. Khan S et al: Papillary lesions of the breast: To excise or observe? Breast J. 24(3):350-355, 2018
                                                                      3. Kiran S et al: Are we overtreating intraductal papillomas? J Surg Res. 231:387-394, 2018
                                                                      4. Lamb LR et al: Pathologic upgrade rates of high-risk breast lesions on digital two-dimensional vs tomosynthesis mammography. J Am Coll Surg. 226(5):858-867, 2018
                                                                      5. Symbol B et al: Management of intraductal papilloma without atypia of the breast diagnosed on core biopsy: Size and sampling matter. Breast J. 24(5):738-742, 2018
                                                                      6. Ahn SK et al: Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: Scoring system for predicting malignancy. Eur J Surg Oncol. ePub, 2017
                                                                      7. Rageth CJ et al: First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 159(2):203-13, 2016
                                                                      8. Yang Y et al: The significance of combined CK5/6 and p63 immunohistochemistry in predicting the risks of subsequent carcinoma development in intraductal papilloma of the breast. Pathol Int. 65(2):81-8, 2015
                                                                      9. Wen X et al: Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol. 20(1):94-101, 2013
                                                                      10. Brennan SB et al: Papilloma diagnosed at MRI-guided vacuum-assisted breast biopsy: is surgical excision still warranted? AJR Am J Roentgenol. 199(4):W512-9, 2012
                                                                      11. Fu CY et al: Papillary breast lesions diagnosed by core biopsy require complete excision. Eur J Surg Oncol. 38(11):1029-35, 2012
                                                                      12. Zhu Y et al: Solitary intraductal papillomas of the breast: MRI features and differentiation from small invasive ductal carcinomas. AJR Am J Roentgenol. 199(4):936-42, 2012
                                                                      13. Chang JM et al: Papillary lesions initially diagnosed at ultrasound-guided vacuum-assisted breast biopsy: rate of malignancy based on subsequent surgical excision. Ann Surg Oncol. 18(9):2506-14, 2011
                                                                      14. Kim MJ et al: The diagnosis of non-malignant papillary lesions of the breast: comparison of ultrasound-guided automated gun biopsy and vacuum-assisted removal. Clin Radiol. 66(6):530-5, 2011
                                                                      15. Jung SY et al: Risk factors for malignancy in benign papillomas of the breast on core needle biopsy. World J Surg. 34(2):261-5, 2010
                                                                      16. Youk JH et al: Atypical papilloma diagnosed by sonographically guided 14-gauge core needle biopsy of breast mass. AJR Am J Roentgenol. 194(5):1397-402, 2010
                                                                      17. Bode MK et al: Ultrasonography-guided core needle biopsy in differential diagnosis of papillary breast tumors. Acta Radiol. 50(7):722-9, 2009
                                                                      18. Cheng TY et al: Risk factors associated with conversion from nonmalignant to malignant diagnosis after surgical excision of breast papillary lesions. Ann Surg Oncol. 16(12):3375-9, 2009
                                                                      19. Tseng HS et al: The management of papillary lesion of the breast by core needle biopsy. Eur J Surg Oncol. 35(1):21-4, 2009
                                                                      20. Ueng SH et al: Papillary neoplasms of the breast: a review. Arch Pathol Lab Med. 133(6):893-907, 2009
                                                                      21. Kil WH et al: Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy? Breast. 17(3):258-62, 2008
                                                                      22. Shin HJ et al: Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy: comparison of sonographic features and biopsy methods. AJR Am J Roentgenol. 190(3):630-6, 2008
                                                                      23. Ko ES et al: Sonographically-guided 14-gauge core needle biopsy for papillary lesions of the breast. Korean J Radiol. 8(3):206-11, 2007
                                                                      24. Lewis JT et al: An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol. 30:665-72, 2006
                                                                      25. Liberman L et al: Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR Am J Roentgenol. 186(5):1328-34, 2006
                                                                      26. Mercado CL et al: Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology. 238(3):801-8, 2006
                                                                      27. Mercado CL et al: Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy. Radiology. 221(3):650-5, 2001
                                                                      28. Orel SG et al: MR imaging in patients with nipple discharge: initial experience. Radiology. 216(1):248-54, 2000
                                                                      29. Hild F et al: Ductal orientated sonography improves the diagnosis of pathological nipple discharge of the female breast compared with galactography. Eur J Cancer Prev. 7 Suppl 1:S57-62, 1998