Multidisciplinary Review of Intraductal Papilloma of the Breast can Identify Patients who may Omit Surgical Excision

2021 ◽  
Author(s):  
Shahrzad Abbassi-Rahbar ◽  
Stephen Sack ◽  
Kelsey E. Larson ◽  
Jamie L. Wagner ◽  
Lyndsey J. Kilgore ◽  
...  
Keyword(s):  
Surgical Excision ◽  
Intraductal Papilloma

scholarly journals Intraductal Papilloma Without Atypia on Image- Guided Breast Biopsy: Upgrade Rates to Carcinoma at Surgical Excision

Breast Care ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. 364-368 ◽  
Author(s):  
Doris Leithner ◽  
Benjamin Kaltenbach ◽  
Petra Hödl ◽  
Volker Möbus ◽  
Volker Brandenbusch ◽  
...  
Keyword(s):  
Needle Biopsy ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Statistical Tests ◽  
Menopausal Status ◽  
Surgical Excision ◽  
Lesion Size ◽  
Intraductal Papilloma ◽  
Image Guided ◽  
Institutional Review

Background: The management of intraductal papilloma without atypia (IDP) in breast needle biopsy remains controversial. This study investigates the upgrade rate of IDP to carcinoma and clinical and radiologic features predictive of an upgrade. Methods: Patients with a diagnosis of IDP on image-guided (mammography, ultrasound, magnetic resonance imaging) core needle or vacuum-assisted biopsy and surgical excision of this lesion at a certified breast center between 2007 and 2017 were included in this institutional review board-approved retrospective study. Appropriate statistical tests were performed to assess clinical and radiologic characteristics associated with an upgrade to malignancy at excision. Results: For 60 women with 62 surgically removed IDPs, the upgrade rate to malignancy was 16.1% (10 upgrades, 4 invasive ductal carcinoma, 6 ductal carcinoma in situ). IDPs with upgrade to carcinoma showed a significantly greater distance to the nipple (63.5 vs. 36.8 mm; p = 0.012). No significant associations were found between upgrade to carcinoma and age, menopausal status, lesion size, microcalcifications, BI-RADS descriptors, initial BI-RADS category, and biopsy modality. Conclusion: The upgrade rate at excision for IDPs diagnosed with needle biopsy was higher than expected according to some guideline recommendations. Observation only might not be appropriate for all patients with IDP, particularly for those with peripheral IDP.

Papillary Breast Lesions: Association with Malignancy and Upgrade Rates on Surgical Excision

2017 ◽  
Vol 83 (11) ◽  
pp. 1294-1297 ◽  
Author(s):  
Hanh-tam Tran ◽  
Asma Mursleen ◽  
Sahar Mirpour ◽  
Omar Ghanem ◽  
Maen J. Farha
Keyword(s):  
Carcinoma In Situ ◽  
Breast Lesion ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Intraductal Papilloma ◽  
Breast Lesions ◽  
Aggressive Approach ◽  
Papillary Lesions ◽  
Benign Papilloma

Intraductal papilloma falls under the category of benign breast mass. However, recent studies show that it can harbor occult carcinoma. The management of benign intraductal papilloma remains controversial because of its nonspecific radiologic and histological findings, as well as its association with surrounding malignant pathology. The purpose of this study is to investigate upgrade rates of a benign intraductal papilloma on surgical excision and the need for surgical excision of papillary lesions diagnosed at core needle biopsy. A retrospective review of a single institution's pathology database between 2011 and 2015 identified 43 core biopsies with benign papilloma. We followed the upgrade rates of these lesions on surgical excision. There were 90 biopsies with the diagnosis of benign intraductal papilloma. The average age was 55.2 (range from 24–87 years old). Forty-three had benign intraductal papilloma; 28 of the 43 core biopsies had surgical excision. Two (7.1%) had an upgrade from benign intraductal papilloma to intraductal papilloma with atypia. One (3.6%) had an upgrade to ductal carcinoma in situ. None had invasive cancer. Surgical findings were in agreement with core biopsies in 25 (89.3%) of 28 cases (κ = 0.80, P < 0.0001). Core biopsies have a statistically significant correlation with pathologies on surgical excision in detecting atypia in breast lesion as demonstrated by κ = 0.80. However, the study shows benign intraductal papillomas on core biopsy have an upgrade rate of 10.7 per cent after undergoing surgical excision. As such, we recommend a more aggressive approach including surgical excision of all benign intraductal papillary lesions.

scholarly journals ASO Visual Abstract: Multidisciplinary Review of Intraductal Papilloma of the Breast Can Identify Patients Who May Omit Surgical Excision

2021 ◽  
Author(s):  
Shahrzad Abbassi-Rahbar ◽  
Stephen Sack ◽  
Kelsey E. Larson ◽  
Jamie L. Wagner ◽  
Lyndsey J. Kilgore ◽  
...  
Keyword(s):  
Surgical Excision ◽  
Intraductal Papilloma

Benign Intraductal Papilloma Diagnosed on Imaging-Guided Breast Biopsy: Upgrade Rate to Carcinoma and to High-Risk Lesion

2021 ◽  
Vol 104 (9) ◽  
pp. 1452-1458
Keyword(s):  
High Risk ◽  
Invasive Carcinoma ◽  
Breast Biopsy ◽  
Early Stage ◽  
Surgical Excision ◽  
Intraductal Papilloma ◽  
Low Grade ◽  
Factors Associated ◽  
High Risk Lesion

Objective: To determine the upgrade rates to carcinoma and to high-risk lesion (HRL) of benign intraductal papilloma (IDP) diagnosed on core needle biopsy (CNB) at Phramongkutklao (PMK) Hospital and to identify clinical or radiologic factors associated with the upgrading. Materials and Methods: Benign IDPs diagnosed on CNB between 2012 and 2020 were retrospectively reviewed. The ones with subsequent surgical excision or with more than two years of imaging follow-up to confirm benignity were included. The upgrade rates to carcinoma and to HRL were determined. Clinical and radiologic factors associated with the upgrade were analyzed. Results: Fifty-six benign IDPs diagnosed on CNB including 41 with subsequent excision and 15 with follow-up management were included. Of the 56 lesions, four (7.14%) were upgraded to carcinoma including three DCIS and one DCIS with grade 1 invasive carcinoma. Upgrade to HRL was found in two lesions (3.57%). No factor was found to be associated with the upgrading. Conclusion: At PMK Hospital, the upgrade rates of benign IDP diagnosed on CNB to carcinoma and to HRL were 7.14% and 3.57%, respectively. No factor was found to be associated with the upgrading. All upgraded cancers were of the early stage and low grade. Case-by-case management is recommended, based on these results together with patient’s risk, patient’s concern, and follow-up compliance. Keywords: Benign intraductal papilloma; Breast carcinoma; Breast biopsy; High risk lesion; Upgrade

Intraductal Papillary Lesions of the Breast: Clinical and Pathological Correlation

2012 ◽  
Vol 78 (10) ◽  
pp. 1161-1165 ◽  
Author(s):  
Daniel Shouhed ◽  
Farin F. Amersi ◽  
Ryan Spurrier ◽  
Catherine Dang ◽  
Kristine Astvatsaturyan ◽  
...  
Keyword(s):  
Needle Biopsy ◽  
Surgical Excision ◽  
Clinical Findings ◽  
Intraductal Papilloma ◽  
Radiological Findings ◽  
Palpable Mass ◽  
Radiographic Findings ◽  
Benign Pathology ◽  
Papillary Lesions ◽  
Malignant Lesions

Papillary lesions of the breast range from a spectrum of benign intraductal papillomas with and without atypia to papillary carcinoma. Distinction between benign and malignant lesions on core needle biopsy (CNB) is difficult without surgical excision. We examined if clinical findings in patients with benign intraductal papillomas (IP) on CNB correlate with pathology at surgical excision. Between 1998 and 2011, 103 patients were identified with a papillary lesion on CNB. Clinical variables were studied to determine if there was clinical correlation with pathological outcomes at final surgical excision. Of the 103 patients, 59 (57%) patients had IP on initial CNB and were included in our analysis. On final pathology, 17 (29%) of these were upstaged to intraductal papilloma with atypia and six (10%) were found to have carcinoma. A clinically palpable mass was the only significant predictor of upstaging to malignancy ( P < 0.05). No radiographic findings were found to be significant predictors of pathological upstaging. In conclusion, surgical excision is still recommended for benign papillary lesions diagnosed on CNB because the correlation with clinical and radiological findings does not assure benign pathology.

Gastric Diverticulum: Diagnosis and Indications for Surgical Excision

1951 ◽  
Vol 18 (2) ◽  
pp. 165-169 ◽  
Author(s):  
Martin L. Tracey ◽  
Bentley P. Colcock
Keyword(s):  
Surgical Excision ◽  
Gastric Diverticulum

Surgical Excision Best for Removing Cylindromas

2011 ◽  
Vol 42 (2) ◽  
pp. 20
Author(s):  
DAMIAN McNAMARA
Keyword(s):  
Surgical Excision

Isolated Lateral Meniscal Tear in the Dog

1988 ◽  
Vol 01 (03/04) ◽  
pp. 152-154
Author(s):  
S. Johnson ◽  
D. Hulse
Keyword(s):  
External Rotation ◽  
Femoral Condyle ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Surgical Excision ◽  
Human Beings ◽  
Stifle Joint ◽  
Microscopic Pathology ◽  
Bucket Handle Tear ◽  
Bucket Handle

degenerative changes of the involved stifle joint associated with a “bucket handle” tear of the caudal body of the lateral meniscus. Surgical excision of the torn section of meniscus was beneficial in the first patient but this patient had persistant difficulty with the leg after exercise. Gross and microscopic pathology of the involved stifle in the second patient showed the meniscal lesion to be associated with severe cartilage fibrillation of the overlying lateral femoral condyle. As in human beings, the mechanism of injury may have been placement of the foot during vigorous external rotation of the femur with the stifle flexed. Extension of the limb from this position could have resulted in an isolated tear of the lateral meniscus.

Prevotella melaninogenica Meningitis and Abscess: A Complication of the Removal of a Midline Dermoid Cyst

2018 ◽  
Vol 15 (03) ◽  
pp. 152-154
Author(s):  
Megan B. Garcia ◽  
Anjali N. Kunz
Keyword(s):  
Dermoid Cyst ◽  
Bacterial Infections ◽  
Surgical Excision ◽  
Sinus Tract ◽  
Neural Tube Closure ◽  
Intracranial Extension ◽  
Dermal Sinus ◽  
Oral Flora ◽  
Prevotella Melaninogenica ◽  
Dermal Sinus Tract

Abstract Prevotella species are gram-negative anaerobic commensal bacteria of the oropharynx, which frequently cause periodontal disease but are otherwise rarely implicated in serious bacterial infections. Cranial dermoid cysts are benign neoplasms that grow along the planes of the embryonic neural tube closure. In infants, they most commonly present in frontal locations, including periorbital, nasal, and within the anterior fontanelle. Although dermoid cysts are slow growing, usually uncomplicated, and easily treated definitively with surgical excision, cranial cysts located on the midline are associated with a higher risk for persistent dermal sinus tract with intracranial extension of the tumor. We describe a case of a 10-month-old male patient with an occipital midline dermoid cyst with intracranial extension, infected with Prevotella melaninogenica, and complicated by intracranial abscess formation and meningitis.This case highlights two unusual disease entities: the uncommon occipital location of a dermoid cyst, and complications of that cyst caused by a serious bacterial infection with a normal oral flora. We discuss the recommendation for neuroimaging prior to surgical excision of a midline dermoid cyst, given the risk for dermal sinus tract with intracranial communication. We also discuss potential mechanisms for bacterial inoculation of this cyst with Prevotella melaninogenica. This pathogen has not previously been reported as a complication of dermoid cysts.

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