Background and Objective: The literature on fine-needle aspiration (FNA) cytology for papillary lesions presents a very mixed picture. Many authors advocate mandatory excision of these lesions. This recommendation is largely based on the ‘atypical’ nature of the FNA report. The aim of this work is to see if breast papillomas can be treated conservatively. Study Design: We report a retrospective study of outcomes for patients with a provisional diagnosis of a ‘papillary breast lesion’ based on assessment by palpation (no clinically suspicious features), sonography (benign or probably benign according to the Breast Imaging Reporting and Data System ‘BI-RADS®’), and FNA (benign cytological category with a papillary architecture) findings from one integrated breast service. Results: Thirty-six cases were identified over a period of 6 years. Thirty-four of the patients had surgical excision. All of the 34 surgical cases were confirmed to be benign in nature on histopathology (intraduct papilloma). The remaining 2 cases were stable on follow-up. Conclusion: We believe that a policy of mandatory excision of papillary lesions of the breast is unnecessarily cautious.

Steinberg JL, Trudeau ME, Ryder DE, Fishell E, Chapman JA, McCready DR, Fish EB, Hiraki GY, Ross TM, Lickley LA: Combined fine-needle aspiration, physical examination and mammography in the diagnosis of palpable breast masses: their relation to outcome for women with primary breast cancer. Canadian Journal of Surgery 1996;39:302–309.
Westenend PJ, Sever AR, Beekman-De Volder HJ, Liem SJ: A comparison of aspiration cytology and core needle biopsy in the evaluation of breast lesions. Cancer 2001;93:146–150.
Vetto J, Pommier R, Schmidt W, Wachtel M, DuBois P, Jones M, Thurmond A: Use of the triple test for palpable breast lesions yields high diagnostic accuracy and cost savings. Am J Surg 1995;169:519–522.
Hermansen C, Skovgaard Poulsen H, Jensen J, Langfeldt B, Steenskov V, Frederiksen P, Jensen OM: Diagnostic reliability of combined physical examination, mammography, and fine-needle puncture (‘triple-test’) in breast tumors: a prospective study. Cancer 1987;60:1866–1871.
Morris KT, Pommier RF, Morris A, Schmidt WA, Beagle G, Alexander PW, Toth-Fejel S, Schmidt J, Vetto JT: Usefulness of triple test score for palpable breast masses. Arch Surg 2001;136:1008–1012.
Sydnor MK, Wilson JD, Hijaz TA, Massey HD, Shaw de Paredes ES: Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy. Radiology 2007;242:58–62.
American College of Radiology: Breast Imaging Reporting and Data System Atlas (BI-RADS® Atlas). 2003. (accessed September 2011).
Ibarra JA: Papillary lesions of the breast. Breast J 2006;12:237–251.
Michael CW, Buschmann B: Can true papillary neoplasms of breast and their mimickers be accurately classified by cytology? Cancer 2002;96:92–100.
Agresti A: Categorical Data Analysis. Wiley, New York, 1990.
Liberman L: Percutaneous image-guided core breast biopsy. Radiol Clin North Am 2002;40:483–500.
Kline TS, Kannan V: Papillary carcinoma of the breast: a cytomorphologic analysis. Arch Pathol Lab Med 1986;110:189–191.
Murad TM, Swaid S, Pritchett P: Malignant and benign papillary lesions of the breast. Hum Pathol 1977;8:379–390.
Naran S, Simpson J, Gupta RK: Cytologic diagnosis of papillary carcinoma of the breast in needle aspirates. Diagn Cytopathol 1988;4:33–37.
Oertel YC, Galblum LI: Fine needle aspiration of the breast: diagnostic criteria. Pathol Annu 1983;18:375–407.
Ricardo HB, Suhrland MJ, Stanley MW: Papillary neoplasms of the breast: fine needle aspiration findings in cystic and solid cases. Diagn Cytopathol 1994;10:336–341.
Tse GM, Ma TK, Lui PC, Ng DC, Yu AM, Vong JS, Niu Y, Chaiwun B, Lam WW, Tan PH: Fine needle aspiration cytology of papillary lesions of the breast: how accurate is the diagnosis? J Clin Pathol 2008;61:945–949.
Valdes EK, Tartter PI, Genelus-Dominique E, Guilbaud DA, Rosenbaum-Smith S, Estabrook A: Significance of papillary lesions at percutaneous breast biopsy. Ann Surg Oncol 2006;13:480–482.
Masood S: Core needle biopsy versus fine needle aspiration biopsy: are there similar sampling and diagnostic issues? Clin Lab Med 2005;25:679–688.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.