Mammograms demonstrate a well-defined, rounded, mass near the nipple in the inner right breast.
Ultrasound demonstrates a corresponding lobulated, solid mass lying within a dilated central duct.
The most likely diagnosis is an intraductal papilloma.
Ultrasound-guided core biopsy confirms a papilloma with no atypia (B3).
Papillomas are classed as B3 lesions, which are indeterminate lesions of uncertain malignant potential. Further investigation is required to exclude coexisting invasive or non-invasive malignancy, but upgrade is mainly associated with B3 lesions with epithelial atypia.
Where no atypia is present, as in this case, the patient can be offered vacuum-assisted excision (VAE) of the lesion. The upgrade rate for papillomas without atypia is 9-13.2%.
However, papillary lesions with atypia on core biopsy have an upgrade rate of 36-47.8% and should undergo surgical diagnostic excision. This allows the lesion to be removed whole rather than piecemeal, facilitating the histological differentiation between atypia and low-grade DCIS.
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