Audit Title: The Post-Surgical Upgrade Rate of Breast Papillary Lesions – A Single Centre Audit
Authors: Suad Al Duwaiki, Farnoosh Tayyari, Faten Al-Douri, Abdullah Alabousi
Presenter’s level of training: Clinical Fellow
Principal Location of Audit: University-based practice

Background and Aim of the Audit: Management of benign intraductal papillomas is controversial because of its nonspecific radiologic findings and the sometimes non-representative histologic findings in the setting of under-sampling. Our aim was to assess the post-surgical upgrade rate of papillary lesions diagnosed at core biopsy. 

Audit Target: Published papillary lesion surgical upgrade rates range from 0-33%. 

Methods: 215 consecutive patients with a papillary lesion diagnosed at core biopsy (stereotactic, ultrasound and MRI) performed between January 2014-June 2018 were reviewed. Core biopsy results were compared with the final surgical pathology upon excision.

Results: Of the 215 patients, 48 were excluded due to lack of surgical pathology (patients did not undergo surgical resection). Of the remaining 167 (age: 41-90, lesion size: 2-46 mm), 97 had a biopsy diagnosis of papilloma, 42 had papilloma with atypia and 28 had papillary carcinoma. Post-operatively, 65 of the 97 benign papillomas had no change in diagnosis (58%). 27 papillomas diagnosed at biopsy were upgraded post-operatively (28%). Upgraded diagnoses included: atypical ductal hyperplasia, ductal carcinoma in-situ, lobular carcinoma in-situ, invasive lobular carcinoma, papilloma with atypia and papillary carcinoma. 

Discussion / Conclusions: When compared with the published rates of papillary lesion upgrade rates, which range from 0-33%, our upgrade rate of 28% is fairly high. At this stage it would be prudent to continue to surgically excise all papillary lesions diagnosed at core biopsy. A potential solution would be to consider vacuum-assisted biopsies for suspected papillary lesions to reduce upgrade rates and decrease the need for surgery.