Intraductal papilloma of the breast: low risk, but handle with care

Introduction: This study aims to investigate the management of patients with breast papillomas without atypia diagnosed after ultrasound-guided vacuum-assisted breast biopsy (VABB). Materials and methods: This retrospective, single-centre study analysed 179 patients diagnosed with benign papillomas without atypia between 1999 and 2022. Of these, 32 patients underwent surgery, while the remaining were managed with active surveillance. Diagnostic underestimation was assessed in the surgical group. The association between post-biopsy residual lesions and subsequent surgical management (surgery vs no surgery) with the incidence of recurrence was evaluated. Results: The study cohort had a median age of 49, with 76% of lesions completely removed via VABB. In the surgery group, 9% (95% CI: 2%–25%) had an underestimation, including upgrades to in situ or invasive carcinoma. Among the 126 patients with available follow-up data, 9 (7%) experienced recurrence events on the same side and in the same quadrant. In the multivariable Fine and Gray regression model, patients with post-biopsy residual lesions managed without surgery had a significantly higher recurrence risk than those without residual lesions (HR = 6.76, p = 0.015). Among patients with post-biopsy residual lesions who underwent surgery, the risk of recurrence was not significantly different from the reference group (HR = 1.80, p = 0.56). Additionally, age at biopsy was identified as an independent risk factor for recurrence (HR = 1.41, p = 0.001), whereas lesion diameter showed no significant association (HR = 1.14, p = 0.49). Conclusions: Surgical resection may be warranted in cases of papillomas with incomplete removal at VABB, where recurrence risk appears to be higher.