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Journal of Breast Disease > Volume 8(1); 2020 > Article
Journal of Breast Disease 2020;8(1): 64-72. doi: https://doi.org/10.14449/jbd.2020.8.1.64
Excision Can Be Delayed until Size Grows in Small Papillary Lesions of the Breast
Jae Young Jang, M.D., Isaac Kim, M.D., Ph.D., Seung Ah Lee, M.D., Seung Ki Kim, M.D.
Division of Breast Surgery, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
Corresponding Author: Seung Ah Lee ,Tel: +82-31-780-5257, Fax: +82-31-780-5266, Email: mdseungah@chamc.co.kr
Received: October 4, 2019    Revised: November 6, 2019    Accepted: April 19, 2020
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ABSTRACT
Purpose: The management of intraductal papilloma (IDP) without atypia remains controversial. This study evaluated the manifestations and incidence of malignancy during observation without surgery in patients diagnosed with IDP by core needle biopsy (CNB), to confirm whether close follow-up instead of surgical treatment is the preferred treatment option in selected patients.
Methods: We retrospectively reviewed the data of 589 patients diagnosed with IDP by CNB between January 2009 to December 2018. The data of the 102 IDP lesions from 90 women who did not undergo immediate excision were analyzed. Of these, 84 patients received imaging follow-up without excision, while 18 patients underwent delayed excision during follow-up.
Results: During the median follow-up period of 18.6 months, the mean change in tumor size and mean percent change in tumor size were −0.06 cm and −0.22%, respectively. Delayed excision was performed in 18 patients (17.6%). In the delayed excision group, three (16.7%) patients and one (5.6%) patient were diagnosed with atypical papilloma and intraductal papillary carcinoma, respectively, based on the final pathological findings. The upstaged group (atypia and malignancy; four patients) showed a 62.0% increase in the tumor size, which is higher than the benign group that showed a 10.4% increase in tumor size. However, the difference was not statistically significant (p=0.185).
Conclusions: Observation without excision is possible for small IDP without atypia, because of the minimal changes in tumor size and low incidence of malignancy after excision. However, to avoid a missed diagnosis of malignancy, excision should be considered if the lesion increases in size during follow-up.
Keywords: Breast | Intraductal papilloma | Neoplasms
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