AB229. SOH26AB_0394b. Upgrade rates and predictive factors for benign intraductal papillomas of the breast
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AB229. SOH26AB_0394b. Upgrade rates and predictive factors for benign intraductal papillomas of the breast

Aine Higgins1, Sandhya Chalasani1, Clara Doran1, Sarah McGarrigle1, Barbara Dunne2, Elizabeth Connolly1

1Department of Breast Surgery, St. James’s Hospital, Dublin, Ireland; 2Department of Pathology, St. James’s Hospital, Dublin, Ireland

Background: Standard management of benign intraductal papillomas (IDPs) diagnosed on core needle biopsy (CNB) is surgical resection, due to the risk of upgrade to in situ or invasive carcinoma. Recent studies demonstrate low rates of upgrade in IDPs without atypia on CNB. The aim of this study was to analyse upgrade rates and risk factors in cases of IDP to predict which subgroups may be managed non-operatively.

Methods: Retrospective analysis was performed on cases of IDP diagnosed on CNB in St. James’s Hospital (SJH) between 2013 and 2023. Rates of upgrade to malignancy on excision were calculated in cases with and without atypia on CNB. Factors predictive of upgrade were identified by logistic regression analysis or Fisher’s exact test.

Results: In IDPs without atypia, 4.68% upgraded to ductal carcinoma in situ (DCIS) or invasive carcinoma. In IDPs with atypia on CNB, the upgrade rate to DCIS or invasive carcinoma was 16.67%. Higher imaging R-score was associated with upgrade (P=0.0006), which was confirmed with Fisher’s exact test (P=0.0017). Age was also predictive (P=0.001). Calcifications demonstrated a non-significant trend towards increased risk (P=0.09). Increasing lesion size was not associated with upgrade.

Conclusions: Low upgrade rates noted in this study in cases of IDP without atypia indicate that certain cases with a favourable risk factor and imaging profile could be considered for surveillance. This study, however, is limited by a small sample size of cases with atypia. Larger-scale prospective studies are needed to further evaluate predictive factors in patient selection.

Keywords: Atypia; papilloma; risk factors; surveillance; upgrade

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-26-ab229
Cite this abstract as: Higgins A, Chalasani S, Doran C, McGarrigle S, Dunne B, Connolly E. AB229. SOH26AB_0394b. Upgrade rates and predictive factors for benign intraductal papillomas of the breast. Mesentery Peritoneum 2026;10:AB229.

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