Papilloma versus papillary DCIS of the breast

Papillary breast lesions include benign papilloma and papillary ductal carcinoma in situ.

Cytokeratins 5/6 and 14, and 34bE12 may help in the differentiation of these lesions:

 

Papilloma

Papillary DCIS

Average immunoscore

score > 50

Average immunoscore

score > 50

Sensitivity of score <50

Specificity of score <50

CK5/6

1081

46/531

121

0/381

100%

92%

CK14

1871

50/531

301

4/381

90%

98%

34bE12

1131

46/531

351

10/351

71%

89%
             

 

Some advocate excision of all papillary lesions detected by core biopsy, on the grounds that they cannot otherwise be reliably classified. In one study2, the diagnosis of papillary lesion on core biopsy was compared with the definitive diagnosis on excision. The diagnosis on the core biopsy was made first using H/E sections alone, then supplemented with stains for p63 (stains only myoepithelial cells), calponin (stains myoepithelial cells and myofibroblasts) and CK5/6 (stains hyperplasia of usual type but not atypical ductal hyperplasia/DCIS):

 Diagnoses are the consensus opinion of four pathologists

core needle biopsy

Excision diagnosis

  

E2 (benign)

E3 (atypical papilloma)

E5 ( malignant)

  

H/E alone

B2 (benign)

33

4

1

  

B3a (florid epithelial proliferation of uncertain nature)

2

0

0

  

B3b (papilloma with focal atypical ductal hyperplasia)

0

6

2

  

B4 (suspicious of DCIS)

0

1

2

  

B5 (DCIS or invasive malignancy)

0

0

55

  

H/E with immunohisto- chemistry

B2 (benign)

35

4

1

  

B3

0

7

3

  

B4 (suspicious of DCIS)

0

0

2

  

B5 (DCIS or invasive malignancy)

0

1

55

  
           

The conclusion of this study is that cases that are assessed as being papilloma clinically, radiologically and on core biopsy augmented by Immunohistochemistry do not require surgical excision2.

 

References

1 Tan PH, Aw MY, Yip G, et al. Cytokeratins in papillary lesions of the breast: is there a role in distinguishing intraductal papilloma from papillary ductal carcinoma in situ? Am J Surg Pathol 2005; 29:625-32

2 Shah VI, Flowers CI, Douglas-Jones AG, et al. Immunohistochemistry increases the accuracy of diagnosis of benign papillary lesions in breast core needle biopsy specimens. Histopathology 2006; 48:683-91

 

This page last revised 31.5.2006.

©SMUHT/PW Bishop