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Haim Gutman, MD; Jacob Schachter, MD; Nir Wasserberg, MD; Itzchak Shechtman, MD; Franklin Greiff, MD

Arch Surg. 2003;138:1330-1333.

Hypothesis  Solitary breast papillomas are potentially malignant and are associated with a higher risk of breast cancer.

Design  Retrospective review of all pathological reports containing breast papilloma (1983-2000) and review of selected specimens.

Setting  Tertiary, referral, university-affiliated medical center.

Participants  Ninety-five women with a breast specimen containing a papilloma or papillomatosis. Patients with overt papillary carcinoma without papilloma were excluded.

Intervention  All histopathological characteristics of the papilloma and the surrounding tissue were noted. The incidence of malignant and other proliferative histopathological findings were analyzed, comparing solitary ductal papilloma cases to multiple papilloma cases. The Fisher exact test and ² test were applied for statistical analysis.

Main Outcome Measures  Surgical removal of solitary ductal papillomas should include margins wide enough to secure removal of any proliferative tissue within or around the papilloma and to enable thorough evaluation of the risk for future breast cancer.

Results  Solitary papillomas were associated with breast carcinoma in 7 patients (10%) in this series. An additional 9% (n = 6) presented with invasive or noninvasive carcinoma within the papilloma. Atypical papilloma was noted in 6% of patients (n = 4). The risk of associated malignancy was not significantly different between solitary ductal papilloma and multiple papilloma.

Conclusion  Increased risk of breast cancer is associated with all forms of papilloma.

From the Departments of Surgery (Drs Gutman, Wasserberg, and Greiff), Oncology (Dr Schachter), and Pathology (Dr Shechtman), Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel, and Sackler School of Medicine, Tel Aviv University (Drs Gutman, Schachter, Shechtman, and Greiff), Tel Aviv, Israel.

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