Should we excise? Are there any clinical or histologic features that predict upgrade in papillomas, incidental or non-incidental?

The clinical decision to excise intraductal papilloma (IDP) without atypia diagnosed on biopsy remains controversial. We sought to establish clinical and histologic predictors (if any) which may predict upgrade in IDP. 296 biopsies (in 278 women) with histologic diagnosis of IDP without atypia were retrospectively identified and placed into Incidental (no corresponding imaging correlate), or Non-incidental (positive imaging correlate) groups. 253/296 (85.5%) cases were non-incidental, and 43/296 (14.5%) were incidental. 73.1% (185/253) non-incidental and 48.8% (21/43) incidental cases underwent excision. 12.4% (23/185) non-incidental cases underwent an upgrade to cancer or high-risk lesion; namely 8-Ductal carcinoma in situ (DCIS), 8-atypical ductal hyperplasia (ADH), 6-lobular neoplasia, and 1-flat epithelial atypia. There was no histopathologic feature on the biopsy in the non-incidental group which predicted upgrade; however a past history of atypia was significantly associated with upgrade. 2 of the 21 incidental cases upgraded (1 to ADH and 1 to lobular neoplasia); the former had a past history of ADH. Both incidental upgrades were >1 mm in size, and were not completely excised on the biopsy. None of the incidental cases which appeared completely excised on biopsy upgraded, irrespective of the size on biopsy. These findings suggest that all non-incidental IDPs should be considered candidates for surgical excision, given the 12.4% upgrade rate and no definitive histologic predictors of upgrade. Patients with incidental IDPs (if <1 mm, completely excised on biopsy and with no history of high risk breast lesion) can be spared excision.



Work Title Should we excise? Are there any clinical or histologic features that predict upgrade in papillomas, incidental or non-incidental?
Open Access
  1. Michael Zaleski
  2. Yun An Chen
  3. Alison Chetlen
  4. Julie Mack
  5. Liyan Xu
  6. Daleela Dodge
  7. Dipti Karamchandani
License In Copyright (Rights Reserved)
Work Type Article
  1. Annals of Diagnostic Pathology
Publication Date August 1, 2018
Publisher Identifier (DOI)
Deposited July 09, 2021




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  • Created
  • Added Should_we_excise_Are_there_any_clinical_or_histologic_features_that_predict_upgrade_in_papillomas_ANNALS__OF_DIAGNOSTIC_PATHOLOGY.pdf
  • Added Creator Michael Zaleski
  • Added Creator Yun An Chen
  • Added Creator Alison Chetlen
  • Added Creator Julie Mack
  • Added Creator Liyan Xu
  • Added Creator Daleela Dodge
  • Added Creator Dipti Karamchandani
  • Published
  • Updated
  • Updated