Factors Associated with Surgical Excision in Patients with Papillary Breast Lesions: A 20-Year Single-Center Experience in South Korea

Background: Patients with incidental benign solitary papilloma of the breast with imaging concordance may be offered follow-up treatment. Recently, as vacuum-assisted breast biopsy (VAB) has become more common, it is increasingly being used as an alternative to core needle biopsy for initial biopsy. This study investigated the factors that necessitate surgical excision after initial needle biopsy of papillary breast lesions. Methods: A retrospective review was conducted of patients diagnosed with papilloma or papillary findings in pathology reports at a single institution between 2001 and 2020. Logistic regression and Cox proportional hazards models were used to analyze the factors associated with surgical excision and papilloma recurrence. Results: Among the 266 patients reviewed, the malignancy upgrade rate was 6.7%, with significantly higher rates in lesions with atypia (p<0.001). Factors associated with the need for surgical excision after initial needle biopsy included older age (odds ratio [OR] =1.064; p=0.015), larger tumor size (OR=3.015; p=0.003), and absence of intraductal lesions (OR=0.049; p<0.001). Additionally, a higher body mass index (BMI) was associated with the recurrence of benign papillary lesions (OR=1.156; p=0.045), and patients with a BMI below 25 showed a significantly lower recurrence rate. Conclusion: Older age, absence of intraductal lesions, and larger tumor size were associated with the likelihood of requiring surgical excision following needle biopsy. These findings suggest that VAB or vacuum-assisted excision should be considered in younger women with smaller intraductal lesions. Additionally, higher BMI was found to be significantly associated with the recurrence of benign papillomas.