Breast pure intraductal papilloma on US-guided core-needle biopsy:potential predictors of upgrading to malignancy
WANG Bo
WANG Wuwan
LEI Huizai
CUI Ligang
WANG Yong
Abstract：Objective To determine the postoperative upgrade rate of pure intraductal papilloma(IDP)diagnosed by ultrasound-guided core needle biopsy(CNB)and identify potential predictors of malignant upgrade,aiming to improve diagnostic accuracy and optimize clinical decision-making.Methods This retrospective study included 114 female patients with pathologically confirmed pure IDP via ultrasound-guided CNB,with a mean age of 45.8±9.3 years and 114 lesions.Based on postoperative pathology,the patients were divided into a benign group(n=108)and a malignant group(n=6).Among them,78 patients underwent additional ultrasound-guided fine-needle aspiration(US-FNA)and were similarly categorized into a benign group(n=73)and a malignant group(n=5)based on surgical pathology.Welch's t-test and Fisher's exact test were used to compare clinical,imaging,and pathological characteristics between benign and malignant groups.Univariate logistic regression analysis was performed.Characteristics showing statistically significant differences in the group comparisons and univariate Logistic regression were further analyzed using multivariate Logistic regression to identify independent predictors of postoperative malignant upgrade.Results Among the 114 pure IDP cases,six(5.3％)were upgraded to malignant postoperatively.Group comparisons and univariate logistic regression analysis showed statistically significant differences between benign and malignant groups in patient age,US-FNA,maximum lesion diameter,presence of microcalcifications,ultrasound BI-RADS category,and ultrasound-pathology concordance,with all these factors showing some correlation with malignant upgrade (P<0.05 for all). Multivariate Logistic regression analysis identified the presence of microcalcifications (OR=9.068,P=0.044) and the detection of atypical/malignant/suspicious cells on US-FNA (OR=19.956,P=0.036) as independent predictors of postoperative malignant upgrade. Conclusion Microcalcifications observed on ultrasound,and presence of atypical,suspicious malignant,or malignant/cells detected by FNA are high-risk factors for malignant upgrade of IDP. Ultrasound-guided FNA can effectively reduce the false-negative rate of CNB,improve diagnostic accuracy for IDP,and assist in clinical decision-making.
Keywords：Ultrasound-guided core-needle biopsyBreastIntraductal papillomaFine needle aspiration
Publication Date：2025-07-15
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 391-396 )