Expert: Claes-Gustaf Nordquist, M.D. - 10/21/2010

Question
A ductogram and MRI confirmed a lesion in my breast of about 1.8 cm.  The
radiologist rated it as ACR 4 and told me she felt strongly it was DCIS.  She is
a leading expert in breast radiology.  The pathology report of the biopsy was
as follows:

(A) Breast, excisional biopsy left
Fibrocystic changes including cyst formation, apocrine metaplasia, and focal
columnar cell change, negative for atypia or malignancy. Cauterized ductal
proliferation consistent with papilloma extending to biopsy margin
(B) Breast excisional biopsy, nipple core
Focal columnar cell hyperplasia, negative for atypia or malignancy

The original report stated the size of the papilloma as 0.15cm.  However after
the surgeon and radiologist questioned it, "several deeper levels were
obtained of the breast tissue specimen A. The cauterized proliferation
consistent with intraductal papilloma was felt to be present in 4 consecutive
sections suggesting that it is at least 1.6cm in length. It does extent to the
inked biopsy margin.  Some reactive ductal epithelial changes can be seen in
one of the central ducts as well with questionable cytologic atypia.  This area
was also reviewed with Dr. XXXX who did not consider it to be atypical."

I suppose because of the error in the original pathology report of the size of
the papilloma, I still have some apprehension.  Am I at higher risk of breast
cancer later because of the papilloma?  Since one pathologist suspected atypia
yet another didn't consider it as such, should I be concerned?

Thank you in advance for your time answering my questions.
Rachel

Answer
So far no malignancy or atypia (the latter at least with any certainty) have been seen. Since however your lesion seems to extend to the biopsy margin I can not guarantee that your whole lesion has been observed and evaluated. Based on that there may be some extra risks involved but based on what has been checked there hardly seems to be any increased risks. That is all I can say at the moment. Continued regular breast check ups including mammography (and ductograms if necessary), ultrasound breast scans & MRI breast scans are recommended - including also breast biopsies if necessary!




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