AB217. SOH26AB_0095. Histologic uncertainty to surgical clarity: institutional insights into malignancy risk in papillary breast lesions

Background: Papillary breast lesions pose a diagnostic and management challenge. While international studies report upgrade rates ranging from 15% to 30%, local data is lacking. This study aimed to offer targeted insights that help avoid unnecessary surgeries and enhance patient outcomes.

Methods: A retrospective review of prospectively maintained pathology database was conducted, and cases of papillary breast lesions which were diagnosed on core biopsies were extracted from January 2023 to December 2025. Patients who underwent subsequent surgical excision were included, and a thorough review of their medical notes, radiology reports, and histology reports was carried out. The rate of upgradation to ductal carcinoma in situ (DCIS) or invasive cancer was recorded, and clinical or radiological predictors of upgrade were explored.

Results: A total of 160 patients were diagnosed to have a papillary lesion on core needle biopsy. Further diagnostic surgical excision was carried out in 158 patients. Two patients chose clinical and mammographic surveillance. The majority of patients were asymptomatic and underwent core needle biopsy for incidental findings upon imaging. The data has been collected and is being analysed. Full results will be included in the final abstract

Conclusions: Papillary lesions of the breast are common histological findings, having a close association with underlying in situ and invasive breast cancer. Their potential of harbouring atypical and malignant disease mandates further diagnostic excision and close clinical follow-up for optimal outcomes.

Keywords: Papillary lesion; invasive breast cancer; ductal carcinoma in situ (DCIS); core biopsy; excisional biopsy