Intracystic papilloma = papilloma in cystically dilated duct
Definitions
Papilloma: Benign ductal neoplasm with proliferation of ductal epithelial and myoepithelial cells supported by frond-forming fibrovascular stalk
Central: Arise in main lactiferous duct, usually solitary
Peripheral: Beyond subareolar region, arise in TDLU, often multiple
Microscopic: < 2 mm, entirely contained in CNB specimen; usually incidental (not seen on imaging and not targeted lesion)
Sclerosing: Focally or completely involved by sclerosis; may mimic invasion
Atypical: Associated with atypical epithelial proliferation and low-grade nuclei meeting criteria for atypical ductal hyperplasia or extent < 3 mm of what would otherwise be low-grade DCIS
Papillomatosis = type of usual ductal hyperplasia (UDH) → papillary hyperplasia but lacks fibrovascular stalks; proliferative lesion with 1.5-2x risk of subsequent breast cancer, but not true papillary lesion
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
Ductography
MR Findings
Image-Guided Biopsy
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Boufelli G et al: Papillomas of the breast: factors associated with underestimation. Eur J Cancer Prev. 27(4):310-314, 2018
Grimm LJ et al: Concordant, non-atypical breast papillomas do not require surgical excision: A 10-year multi-institution study and review of the literature. Clin Imaging. 51:180-185, 2018
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
Mishima C et al: Mutational Analysis of AKT1 and PIK3CA in Intraductal Papillomas of the Breast with Special Reference to Cellular Components. Am J Pathol. 188(5):1106-1112, 2018
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
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
Bahl M et al: JOURNAL CLUB: Diagnostic utility of MRI after negative or inconclusive mammography for the evaluation of pathologic nipple discharge. AJR Am J Roentgenol. 209(6):1404-1410, 2017
Expert Panel on Breast Imaging:. et al: ACR Appropriateness Criteria® Evaluation of Nipple Discharge. J Am Coll Radiol. 14(5S):S138-S153, 2017
Scarpa Carniello JV et al: Diagnostic dilemmas and pitfalls in ThinPrep® cytology of breast fine needle aspiration biopsy:: Report of Six Cases with Histological Correlates. Diagn Cytopathol. 45(7):655-661, 2017
Yildiz S et al: Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of papillary breast lesions. Breast J. ePub, 2017
Yoon JH et al: Ultrasonographic evaluation of women with pathologic nipple discharge. Ultrasonography. 36(4):310-320, 2017
Ni YB et al: Pathological criteria and practical issues in papillary lesions of the breast - a review. Histopathology. 68(1):22-32, 2016
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
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
C Ang D et al: Frequent phosphatidylinositol-3-kinase mutations in proliferative breast lesions. Mod Pathol. 27(5):740-50, 2014
Choi SH et al: Clinical and imaging characteristics of papillary neoplasms of the breast associated with malignancy: a retrospective cohort study. Ultrasound Med Biol. 40(11):2599-608, 2014
Maxwell AJ et al: Benign papilloma diagnosed on image-guided 14 G core biopsy of the breast: Effect of lesion type on likelihood of malignancy at excision. Clin Radiol. 68(4):383-7, 2013
Nayak A et al: Benign papillomas without atypia diagnosed on core needle biopsy: experience from a single institution and proposed criteria for excision. Clin Breast Cancer. 13(6):439-49, 2013
Sohn YM et al: Comparison of sonographically guided core needle biopsy and excision in breast papillomas: clinical and sonographic features predictive of malignancy. J Ultrasound Med. 32(2):303-11, 2013
Swapp RE et al: Management of benign intraductal solitary papilloma diagnosed on core needle biopsy. Ann Surg Oncol. 20:1900-5, 2013
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
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
Fu CY et al: Papillary breast lesions diagnosed by core biopsy require complete excision. Eur J Surg Oncol. 38(11):1029-35, 2012
Holley SO et al: Pathologic outcomes of nonmalignant papillary breast lesions diagnosed at imaging-guided core needle biopsy. Radiology. 265(2):379-84, 2012
Lee KA et al: Risk of malignancy when microscopic radial scars and microscopic papillomas are found at percutaneous biopsy. AJR Am J Roentgenol. 198(2):W141-5, 2012
Li X et al: Microcalcification is an important factor in the management of breast intraductal papillomas diagnosed on core biopsy. Am J Clin Pathol. 138:789-95, 2012
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
Chang JM et al: Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat. 129(1):89-97, 2011
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
Youk JH et al: Benign papilloma without atypia diagnosed at US-guided 14-gauge core-needle biopsy: clinical and US features predictive of upgrade to malignancy. Radiology. 258(1):81-8, 2011
Chang JM et al: Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study. Eur Radiol. 20(5):1093-100, 2010
Debnath D et al: Multiple Papillomatosis of Breast and Patient's Choice of Treatment. Patholog Res Int. 2010:540590, 2010
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
Troxell ML et al: High prevalence of PIK3CA/AKT pathway mutations in papillary neoplasms of the breast. Mod Pathol. 23(1):27-37, 2010
Chang JM et al: Does ultrasound-guided directional vacuum-assisted removal help eliminate abnormal nipple discharge in patients with benign intraductal single mass? Korean J Radiol. 10(6):575-80, 2009
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
Maxwell AJ: Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience. Clin Radiol. 64(8):801-6, 2009
Rosen PP: Papilloma and Related Benign Tumors. In Rosen PP: Rosen's Breast Pathology. Philadelphia: Lippincott Williams & Wilkins. 85-136, 2009
Muttarak M et al: Spectrum of papillary lesions of the breast: clinical, imaging, and pathologic correlation. AJR Am J Roentgenol. 191(3):700-7, 2008
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
Skandarajah AR et al: Benign papilloma on core biopsy requires surgical excision. Ann Surg Oncol. 15(8):2272-7, 2008
Bhattarai N et al: Intraductal papilloma: features on MR ductography using a microscopic coil. AJR Am J Roentgenol. 186(1):44-7, 2006
Lewis JT et al: An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol. 30(6):665-72, 2006
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
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
Mercado CL et al: Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology. 238(3):801-8, 2006
Nelson RS et al: Twenty-year outcome following central duct resection for bloody nipple discharge. Ann Surg. 243(4):522-4, 2006
Dooley WC et al: Office-based breast ductoscopy for diagnosis. Am J Surg. 188(4):415-8, 2004
Daniel BL et al: Magnetic resonance imaging of intraductal papilloma of the breast. Magn Reson Imaging. 21(8):887-92, 2003
Mercado CL et al: Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy. Radiology. 221(3):650-5, 2001
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
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References
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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Synonyms
Intraductal papilloma
Large duct papilloma = central papilloma
Intracystic papilloma = papilloma in cystically dilated duct
Definitions
Papilloma: Benign ductal neoplasm with proliferation of ductal epithelial and myoepithelial cells supported by frond-forming fibrovascular stalk
Central: Arise in main lactiferous duct, usually solitary
Peripheral: Beyond subareolar region, arise in TDLU, often multiple
Microscopic: < 2 mm, entirely contained in CNB specimen; usually incidental (not seen on imaging and not targeted lesion)
Sclerosing: Focally or completely involved by sclerosis; may mimic invasion
Atypical: Associated with atypical epithelial proliferation and low-grade nuclei meeting criteria for atypical ductal hyperplasia or extent < 3 mm of what would otherwise be low-grade DCIS
Papillomatosis = type of usual ductal hyperplasia (UDH) → papillary hyperplasia but lacks fibrovascular stalks; proliferative lesion with 1.5-2x risk of subsequent breast cancer, but not true papillary lesion
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
Ductography
MR Findings
Image-Guided Biopsy
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Boufelli G et al: Papillomas of the breast: factors associated with underestimation. Eur J Cancer Prev. 27(4):310-314, 2018
Grimm LJ et al: Concordant, non-atypical breast papillomas do not require surgical excision: A 10-year multi-institution study and review of the literature. Clin Imaging. 51:180-185, 2018
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
Mishima C et al: Mutational Analysis of AKT1 and PIK3CA in Intraductal Papillomas of the Breast with Special Reference to Cellular Components. Am J Pathol. 188(5):1106-1112, 2018
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
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
Bahl M et al: JOURNAL CLUB: Diagnostic utility of MRI after negative or inconclusive mammography for the evaluation of pathologic nipple discharge. AJR Am J Roentgenol. 209(6):1404-1410, 2017
Expert Panel on Breast Imaging:. et al: ACR Appropriateness Criteria® Evaluation of Nipple Discharge. J Am Coll Radiol. 14(5S):S138-S153, 2017
Scarpa Carniello JV et al: Diagnostic dilemmas and pitfalls in ThinPrep® cytology of breast fine needle aspiration biopsy:: Report of Six Cases with Histological Correlates. Diagn Cytopathol. 45(7):655-661, 2017
Yildiz S et al: Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of papillary breast lesions. Breast J. ePub, 2017
Yoon JH et al: Ultrasonographic evaluation of women with pathologic nipple discharge. Ultrasonography. 36(4):310-320, 2017
Ni YB et al: Pathological criteria and practical issues in papillary lesions of the breast - a review. Histopathology. 68(1):22-32, 2016
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
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
C Ang D et al: Frequent phosphatidylinositol-3-kinase mutations in proliferative breast lesions. Mod Pathol. 27(5):740-50, 2014
Choi SH et al: Clinical and imaging characteristics of papillary neoplasms of the breast associated with malignancy: a retrospective cohort study. Ultrasound Med Biol. 40(11):2599-608, 2014
Maxwell AJ et al: Benign papilloma diagnosed on image-guided 14 G core biopsy of the breast: Effect of lesion type on likelihood of malignancy at excision. Clin Radiol. 68(4):383-7, 2013
Nayak A et al: Benign papillomas without atypia diagnosed on core needle biopsy: experience from a single institution and proposed criteria for excision. Clin Breast Cancer. 13(6):439-49, 2013
Sohn YM et al: Comparison of sonographically guided core needle biopsy and excision in breast papillomas: clinical and sonographic features predictive of malignancy. J Ultrasound Med. 32(2):303-11, 2013
Swapp RE et al: Management of benign intraductal solitary papilloma diagnosed on core needle biopsy. Ann Surg Oncol. 20:1900-5, 2013
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
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
Fu CY et al: Papillary breast lesions diagnosed by core biopsy require complete excision. Eur J Surg Oncol. 38(11):1029-35, 2012
Holley SO et al: Pathologic outcomes of nonmalignant papillary breast lesions diagnosed at imaging-guided core needle biopsy. Radiology. 265(2):379-84, 2012
Lee KA et al: Risk of malignancy when microscopic radial scars and microscopic papillomas are found at percutaneous biopsy. AJR Am J Roentgenol. 198(2):W141-5, 2012
Li X et al: Microcalcification is an important factor in the management of breast intraductal papillomas diagnosed on core biopsy. Am J Clin Pathol. 138:789-95, 2012
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
Chang JM et al: Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat. 129(1):89-97, 2011
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
Youk JH et al: Benign papilloma without atypia diagnosed at US-guided 14-gauge core-needle biopsy: clinical and US features predictive of upgrade to malignancy. Radiology. 258(1):81-8, 2011
Chang JM et al: Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study. Eur Radiol. 20(5):1093-100, 2010
Debnath D et al: Multiple Papillomatosis of Breast and Patient's Choice of Treatment. Patholog Res Int. 2010:540590, 2010
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
Troxell ML et al: High prevalence of PIK3CA/AKT pathway mutations in papillary neoplasms of the breast. Mod Pathol. 23(1):27-37, 2010
Chang JM et al: Does ultrasound-guided directional vacuum-assisted removal help eliminate abnormal nipple discharge in patients with benign intraductal single mass? Korean J Radiol. 10(6):575-80, 2009
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
Maxwell AJ: Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience. Clin Radiol. 64(8):801-6, 2009
Rosen PP: Papilloma and Related Benign Tumors. In Rosen PP: Rosen's Breast Pathology. Philadelphia: Lippincott Williams & Wilkins. 85-136, 2009
Muttarak M et al: Spectrum of papillary lesions of the breast: clinical, imaging, and pathologic correlation. AJR Am J Roentgenol. 191(3):700-7, 2008
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
Skandarajah AR et al: Benign papilloma on core biopsy requires surgical excision. Ann Surg Oncol. 15(8):2272-7, 2008
Bhattarai N et al: Intraductal papilloma: features on MR ductography using a microscopic coil. AJR Am J Roentgenol. 186(1):44-7, 2006
Lewis JT et al: An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol. 30(6):665-72, 2006
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
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
Mercado CL et al: Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology. 238(3):801-8, 2006
Nelson RS et al: Twenty-year outcome following central duct resection for bloody nipple discharge. Ann Surg. 243(4):522-4, 2006
Dooley WC et al: Office-based breast ductoscopy for diagnosis. Am J Surg. 188(4):415-8, 2004
Daniel BL et al: Magnetic resonance imaging of intraductal papilloma of the breast. Magn Reson Imaging. 21(8):887-92, 2003
Mercado CL et al: Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy. Radiology. 221(3):650-5, 2001
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
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