Table 2 Upgrades at follow-up surgical excision of intraductal papilloma without atypia diagnosed at core needle biopsy.
Author, ref. | CNBs | Radiology–pathology concordance assessed | Carcinoma at excision (%) | Factors associated with upgrade | Atypical lesions at EXC (%) [type of atypia] | Recommendation [comments] | |||
|---|---|---|---|---|---|---|---|---|---|
All carcinomas (%) | Invasive (%) [type of carcinoma] | DCIS (%) [type of carcinoma] | Concordance of cases with upgrade | ||||||
Bennet et al. [45] | 45 | YES | 0 | 0 | 0 | Not applicable | NS | NS | No EXCISION |
Chang et al. [27] | 100 | YES | 4 (4%) | 1 (1%) | 3 (3%) [two DCIS in IDP; one DCIS] | Two of four cases discordant | Size >1.5 cm | 13 (13%) [13 atypical IDP or ADH near IDP] | No EXCISION |
Chang et al. [26] | 64 | YES | 0 | 0 | 2 (3.1%) [two papillary DCIS] | NS | NS | 7 (6.1%) [seven atypical IDPs] | No EXCISION |
Cyr et al. [24] | 82 | NS | 8 (9.7%) | 3 (3.6%) [two invasive carcinomas; one IPC] | 5 (6%) | One of eight cases discordant | None | 10 (12.2%) [six ADH, four ALH/LCIS] | EXCISION |
Fu et al. [20] | 203 | NS | 12 (5.9%) | 0 | 12 (5.9%) | NS | Peripheral location | 41 (20.2%) | EXCISION |
Rizzo et al. [21] | 234 | NS | 21 (8.9%) | 2 (0.8%) | 19 (8.1%) | NS | Older age | 42 (17.9%) [42 ADH] | EXCISION |
Li et al. [28] | 370 | NS | 7 (2%) | 1 (0.3%) | 6 (1.6%) [five DCIS and one P-LCIS] | NS | Calcifications | 55 (14.8%) [48 ADH, 7 ALH/LCIS] | No EXCISION |
Swapp et al. [29] | 77 | YES | 0 | 0 | 0 | Not applicable | None | NS | No EXCISION |
Foley et al. [22] | 146 | NS | 7 (4.7%) | NS | NS | NS | Older age | 25 (17%) | EXCISION |
Glenn et al. [23] | 146 | NS | 7 (4.7%) | NS | NS | NS | Older age | 25 (17%) | EXCISION |
Nakhlis et al. [30] | 45 | YES | 3 (6.7%) | 1 (2.2%) | 2 (4.4%) | Three of three cases discordant | Palpable mass | NS | No EXCISION |
Pareja et al. [31] | 171 | YES | 4 (2.3%) | 2 (1.1%) | 2 (1.1%) [one DCIS in IDP; one DCIS] | NS | Synchronous carcinoma | 31 (18.1%) [19 ADH, 11 ALH/LCIS, 1 FEA] | No EXCISION |
Hong et al. [32] | 234 | YES | 14 (6%) | 5 (2%) | 9 (4%) | NS | Age >54 years (OR = 4.351); size >1 cm (OR = 4.236) | NS | No EXCISION [if age <54 years and size <1 cm] |
Kim et al. [33] | 141 | YES | 6 (4.25%) | 2 (1.4%) | 4 (2.8%) | Two of six cases discordant | (No upgrades for IDP confirmed with IHC) | 9 (6.3%) [eight ADH, one LCIS] | No EXCISION |
Han et al. [34] | 383 | YES | 3 (0.8%) | 0 | 3 (0.8%) | NS | Clinical symptoms; concurrent contralateral carcinoma; multifocality | 17 (4.4%) [ten ADH, seven ALH/LCIS] | No EXCISION |
Ahn et al. [35] | 250 | NS | 17 (6.8%) | 6 (2.4%) | 11 (4.4%) | NS | Bloody discharge; peripheral location;palpable mass; size ≥15 mm; BI-RADS ≥ 4b | 27 (10.4%) [27 ADH] | No EXCISION |
Grimm et al. [42] | 136 | YES | 0 | 0 | 0 | Not applicable | None | NS | No EXCISION |
Kuehner et al. [36] | 327 | NS | 19 (5.8%) | 8 (2.4%) [three IPCs; five invasive carcinomas] | 11 (3.4%) [seven DCIS, four “papillary carcinomas”] | NS | Age >50 years; size >1 cm; peripheral location; palpable mass | 31 (9.5%) [4.9% ADH, 2.1% ALH/LCIS, 2.5% atypical IDPs] | No EXCISION [excision and surveillance are equivalent] |
MacColl et al. [37] | 180 | NS | 17 (9.4%) | 5 (2.7%) | 12 (6.6%) [one EPC; two papillary DCIS; one papillary/micropapillary DCIS; eight DCIS] | NS | Older age; size >0.5 cm; calcifications | 3 (1.6%) [three LCIS] | No EXCISION |
Choi et al. [38] | 206 removed by EXC | NS | 4 (1.9%) | 0 | 4 (1.9%) | NS | NS | 17 (8%) [12 ADH, 4 ALH, 1 FEA] | No EXCISION [favor US-VAB removal or US follow-up] |
233 removed by US-VAB | 5 (2.1%) | 1 (0.4%) | 4 (1.7%) | NS | 6 (1.9%) [four ADH, one ALH, one FEA] | ||||
Chen et al. [25] | 206 | YES | 8 (3.9%) | 0 | 8 (3.9%) | Eight of eight cases concordant | NS | 16 (7.8%) [nine ADH, seven ALH/LCIS] | EXCISION |
Yu et al. [40] | 50 | YES | 2 (4%) | 0 | 2 (4%) | Two of two cases discordant | Older age; large size; peripheral location | NS | No EXCISION [for younger patients with small central IDPs] |
Moynihan et al. [43] | 124 | NS | 3 (2.4%) | 0 | 3 (2.4%) | NS | NS | 15 (12.1%) | No EXCISION |
Genco et al. [44] | 26 | NS | 2 (1.6%) | 0 | 2 (1.6%) | NS | Size >1 cm | 14 (11.1%) [eight ADH, six ALH/LCIS] | No EXCISION |
