LAUSR

Management of intraductal papilloma (IDP) of the breast diagnosed on percutaneous core needle biopsy (CNB) has traditionally involved surgical excision to rule out upgrade to underlying malignancy. The upgrade rate to ductal carcinoma in situ (DCIS) or invasive breast cancer on surgical pathology could be as high as 41%, justifying the need for excision. (1) A number of patient demographic, radiologic, and pathologic features have been explored in multiple studies to determine which features are more likely to result in upgrade. (2) Features believed to have an increased risk of upgrade include increased patient age, presenting symptoms of nipple discharge or palpable mass, increase in imaging size, or the presence of atypical hyperplasia. However, a consensus on which factors, when present or absent, could result in active monitoring has not been uniformly accepted. Concern for missed malignancy at the IDP site has resulted in routine excision for all IDP as common practice.