Factors associated with histologic upgrade following surgical excision of breast papillomas: a retrospective multicenter study.
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Denizoğlu Nurper, Taşkın Füsun, İçten Gül Esen, Oktay Ayşenur, Aslan Özge, Tunçbilek Nermin, Balcı Pınar, Arıbal Erkin, Çelik Levent, Örgüç Şebnem, Demirkazık Figen, Gültekin Serap, Murat Aydın Ayşe, Durmaz Emel, Kul Sibel, Binokay Figen, Çetin Meltem, Emlik Ganime Dilek, Akpınar Meltem Gülsün, Voyvoda Nuray, Polat Ahmet Veysel, Başara Akın Işıl, Yıldız Şeyma, Poyraz Necdet, Özsoy Arzu, Öztekin Pelin, Elverici Eda, Bayrak İlkay Koray, İkizceli Türkan, Dolu Alev, Dinç Funda, Sezgin Gülten, Gülşen Gökçe, Tunçbilek Işıl, Yalçın Sabiha Rabia, Çolakoğlu Gül, Ağlamış Serpil, Yılmaz Ravza, Rona Günay, Durhan Gamze, Güner Davut Can, Çelik Yabul Fatma, Günbey Karabekmez Leman, Tutar Burçin, Göktaş Muhammet, Buğdaycı Onur, Tokat Fatma, Şeker Mustafa Ege, Uras Cihan
Аннотация
METHODS: In this retrospective multicenter study, 527 surgically excised papillary lesions from 30 centers were evaluated. Malignant upgrade was defined as malignancy at excision after a biopsy diagnosis of papilloma with or without atypia; high-risk upgrade was defined as a high-risk lesion at excision after papilloma without atypia. Overall diagnostic upgrade comprised either outcome. Multivariable logistic regression assessed age, lesion size, risk status, presence of symptoms, and radiologic-pathologic concordance.
RESULTS: Papilloma without atypia accounted for 407 lesions, and papilloma with atypia for 120. The overall malignant upgrade rate was 21.4% (113/527). Among papillomas without atypia, high-risk and malignant upgrade rates were 19.7% (80/407) and 14.2% (58/407), respectively; among papillomas with atypia, malignant upgrade was 45.8% (55/120). Overall diagnostic upgrade occurred in 36.6% (193/527). Multivariable analysis identified older age [odds ratio (OR), 1.03 per year; 95% confidence interval (CI), 1.02-1.05], larger lesion size (OR, 1.02 per mm; 95% CI, 1.00-1.03), presence of symptoms (OR, 1.69; 95% CI, 1.15-2.49), and radiologic-pathologic discordance (concordance OR, 0.54; 95% CI, 0.35-0.84) as independent predictors of upgrade. Microcalcifications (OR, 2.47; 95% CI, 1.27-4.85) and asymmetry (OR, 2.18; 95% CI, 1.12-4.25) on mammography were also significantly associated with upgrade.
CONCLUSION: In this retrospective multicenter cohort of surgically excised, biopsy-proven papillary lesions, atypia and several clinical and imaging factors were associated with diagnostic upgrade. These findings may support individualized management decisions in patients with papillary breast lesions.
CLINICAL SIGNIFICANCE: Identifying clinical and imaging predictors of upgrade may facilitate risk-adapted management of papillary breast lesions and help avoid unnecessary surgical excision in carefully selected patients.