Papillary Lesions of the Breast: A Comprehensive Guide

Papillary lesions of the breast are a common finding on imaging exams. They can range from benign to malignant, and their evaluation and management can be challenging. This article aims to provide a comprehensive overview of papillary lesions of the breast, including their presentation, diagnosis, and treatment.

Definition

A papillary lesion of the breast is a mass or area of thickening that projects from the surface of the breast tissue. It is often detected on imaging exams, such as mammograms or ultrasound.

Classification

Papillary lesions of the breast are classified based on their pathology. The two main types of papillary lesions are:

1. Intraductal Papilloma (IP)

• Benign lesion
• Arises from the lining of a milk duct
• May cause nipple discharge or a palpable mass

2. Papillary Carcinoma (PC)

• Malignant lesion
• Arises from the lining of a milk duct
• May cause nipple discharge, a palpable mass, or skin changes

Incidence

Papillary lesions of the breast are common. IPs are the most common benign breast lesion, accounting for approximately 5% of all breast biopsies. PCs are less common, but they are the most common type of breast cancer that arises from a milk duct.

Clinical Presentation

The clinical presentation of papillary lesions of the breast can vary depending on the type of lesion.

IPs

• Often asymptomatic
• May cause nipple discharge or a palpable mass
• Nipple discharge may be bloody or clear
• Mass is usually small and mobile

PCs

• May cause nipple discharge or a palpable mass
• Nipple discharge may be bloody or clear
• Mass may be fixed to the surrounding tissue
• Skin changes may occur, such as dimpling or retraction

Diagnosis

The diagnosis of papillary lesions of the breast is typically made based on imaging exams and biopsy.

Imaging Exams

• Mammogram
• Ultrasound
• MRI

Biopsy

• Core needle biopsy
• Excisional biopsy

Frozen Section Examination

• Frozen section examination can be performed during a biopsy to assess the pathology of the lesion. This can help guide the surgeon's decision-making regarding further treatment.

Treatment

The treatment of papillary lesions of the breast depends on the type of lesion.

IPs

• Benign lesions that do not require treatment in most cases
• May be treated with observation or surgery if symptoms are bothersome

PCs

• Malignant lesions that require treatment
• Treatment options include surgery, radiation therapy, and chemotherapy
• The type of treatment recommended will depend on the size and stage of the cancer

Prognosis

The prognosis of papillary lesions of the breast is generally good.

IPs

• Benign lesions with an excellent prognosis
• Recurrence is rare

PCs

• Prognosis depends on the size and stage of the cancer
• Five-year survival rates range from 85% to 95% for patients with early-stage PC
• Five-year survival rates decrease to 50% to 70% for patients with late-stage PC

Conclusion

Papillary lesions of the breast are a common finding on imaging exams. They can range from benign to malignant, and their evaluation and management can be challenging. This article has provided a comprehensive overview of papillary lesions of the breast, including their presentation, diagnosis, and treatment.

Stories

Story 1: The Patient Who Self-Examined

A 50-year-old woman felt a small lump in her breast. She was alarmed, but she decided to wait and see if it would go away. After a few months, the lump had not changed, so she went to see her doctor. The doctor ordered a mammogram, which showed a papillary lesion. The lesion was biopsied, and the pathology report came back as benign. The woman was relieved, but she was also glad that she had self-examined her breasts and sought medical attention when she felt something unusual.

Lesson Learned: Self-examination is an important part of breast cancer screening. Women should be familiar with the normal appearance and feel of their breasts so that they can identify any changes.

Story 2: The Patient Who Ignored Symptoms

A 40-year-old woman had been experiencing nipple discharge for several months. She ignored the discharge because she thought it was nothing serious. Eventually, the discharge became bloody, and the woman went to see her doctor. The doctor ordered a mammogram, which showed a papillary lesion. The lesion was biopsied, and the pathology report came back as malignant. The woman was diagnosed with papillary carcinoma of the breast. She underwent surgery, radiation therapy, and chemotherapy. After treatment, she is now cancer-free.

Lesson Learned: It is important to see a doctor if you experience any changes in your breasts, even if you think they are not serious. Ignoring symptoms can lead to a delay in diagnosis and treatment, which can affect the prognosis of the cancer.

Story 3: The Patient Who Was Overtreated

A 60-year-old woman had a mammogram that showed a papillary lesion. The lesion was biopsied, and the pathology report came back as benign. The woman's doctor recommended that she have a lumpectomy to remove the lesion. The woman agreed to the surgery, but she was later diagnosed with breast cancer in the same breast. The cancer was unrelated to the papillary lesion that had been removed.

Lesson Learned: Not all papillary lesions of the breast need to be treated surgically. Surgery is only recommended for lesions that are suspected to be malignant or that are causing symptoms. Unnecessary surgery can lead to complications and anxiety.

Tables

Table 1: Incidence of Papillary Lesions of the Breast

Table 2: Clinical Presentation of Papillary Lesions of the Breast

Table 3: Treatment Options for Papillary Lesions of the Breast

Effective Strategies

• Self-examination: Women should be familiar with the normal appearance and feel of their breasts so that they can identify any changes.
• Mammography: Mammograms are an important tool for detecting papillary lesions of the breast.
• Ultrasound: Ultrasound can be used to further evaluate papillary lesions and to guide biopsies.
• MRI: MRI can be used to provide additional information about papillary lesions, especially in cases where the mammogram and ultrasound findings are inconclusive.
• Biopsy: Biopsy is the definitive way to diagnose a papillary lesion of the breast.
• Treatment: The treatment of papillary lesions of the breast depends on the type of lesion and its characteristics.

Pros and Cons

Pros of Surgical Treatment for Papillary Lesions of the Breast

• Can remove the lesion completely
• Can provide a definitive diagnosis
• Can relieve symptoms

Cons of Surgical Treatment for Papillary Lesions of the Breast

• Can cause complications, such as infection, bleeding, and scarring
• May not be necessary for all papillary lesions
• Can lead to anxiety