Clinical and Imaging Characteristics of Papillary Neoplasms of the Breast Associated with Malignancy: A Retrospective Cohort Study

Papillary neoplasms of the breast comprise a broad range of pathologies ranging from papillomas to papillary carcinomas and have been associated with breast cancers. In this study, we evaluated the clinical, mammographic and sonographic features of papillary breast neoplasms from benign papillary breast lesions to malignancy-associated papillary lesions. A total of 194 lesions in 179 patients were analyzed, including 117 benign papillomas, 24 atypical papillomas, 41 benign papillomas with malignancies and 12 papillary carcinomas found between January 2003 and August 2011 in our institution. Statistically significant clinical factors included patient age (p = 0.001), lesion multiplicity (p = 0.009) and peripheral location (p = 0.003). Among these factors, the odds ratio for malignancy was 8.9 for bilateral multiple lesions. Visibility (p = 0.001) and density (p = 0.039) were significant factors for malignancy in mammograms, and echo patterns (p = 0.006), boundary (p = 0.001) and vascularity (p = 0.005) were significant features on ultrasound that differentiated malignancies from benign lesions. Overall, when papillary breast lesions are located bilaterally and peripherally in older patients, they are correlated with breast cancers. Additionally, for papillary breast lesions that appear highly dense on mammograms and/or exhibit positive vascularity on ultrasound, the probability of malignancy is relatively high.