Clinical, Radiological and Pathological Correlation of Papillary Lesions of the Breast

Papillary lesions of the breast are a heterogenous group of neoplasms having varied clinical and radiological presentations and variable management and prognosis. They are difficult to diagnose leading to management dilemmas. This study aims to analyse the clinical presentations, radiological features and pathological characteristics of the patients with papillary breast lesions. This is a retrospective study of patients with papillary lesions of the breasts who underwent surgery in our institute. Medical records were retrieved, and clinical, radiological presentations were correlated with histopathological findings. In this study, 37 patients with 40 papillary lesions of breast (3 bilateral) were operated in 4 years. Median age was 62 years. Final histopathological diagnosis was benign papillary in 27 lesions (67.5%), atypical ductal hyperplasia in 3 lesions (7.5%) and malignancy in 10 lesions (25%). The radiological findings were concordant with pathological findings in 34 out of 40 lesions (85%) with a significant p value of 0.006. However, malignancy was not accurately predicted using imaging alone (sensitivity 50%, specificity 96.67%, PPV 83.33% and NPV 85.29%). Core biopsy was inaccurate in 21.7% of lesions and showed a sensitivity of 62.5%, specificity of 100%, PPV of 100% and NPV of 83.33% in the diagnosis of malignancy. Though there is a good correlation between imaging modalities and histopathology findings in papillary lesions of the breast, upgrade rates to malignancy cannot be ignored. The underestimation rates of core biopsy are also high. Hence, surgical resection should be done for palpable papillomas and papillomas with atypia and also lesions with pathology-imaging discordance. Incidental and clear cut benign papillomas may be followed up with an individualised decision for resection.