Can we now reach a consensus on the management of benign papillary breast lesions?

Management of benign breast lesions diagnosed by core needle biopsy (CNB) remains a controversial topic. Specifically, there is no consensus on the management of intraductal papillomas, despite multiple studies to determine whether excision or observation should be the next best step (1-5). When CNB yields a diagnosis of intraductal papilloma with atypia, excisional biopsy of the lesion is generally performed. For intraductal papillomas without atypia, however, a large retrospective study recently published in the Annals of Surgical Oncology suggests that observation without excision is likely a safe alternative (6). This is based on a low rate of malignancy found on surgical excision of 327 lesions diagnosed as benign papillomas on CNB, as well as no incidence of cancer found on follow-up for those (n=61) who did not undergo excision.