What Is the Treatment for Intraductal Papilloma?

The female mammary gland has 15 to 20 mammary ducts that open into the nipple. Intraductal papilloma of the breast refers to benign tumors that occur in the ductal epithelium, and its incidence is second only to breast fibroadenomas and breast cancer. According to the 2003 World Health Organization (WHO) classification of breast tumors, intraductal papillomas are classified into central and peripheral types. Central papilloma mostly occurs in grades 1 and 2 of the breast, about 1.5 cm below the ampulla of the duct (the ampulla refers to the area where the duct closes to the nipple and expands into a cystic shape). It is also called a large ductal papilloma. The central part of the breast is below the areola and is generally not considered to increase the risk of breast cancer. Peripheral papilloma refers to multiple intraductal papilloma that occurs in the terminal duct-lobular system. It has been used under the name "papilloma disease" and is located in the peripheral quadrant of the breast. It is generally considered to be a precancerous lesion and the rate of canceration. It is 5% to 12%. Intraductal papilloma of the breast is more common in postpartum women, and most of them are 40-50 years old. It is a common clinical benign tumor of the breast.

Basic Information

Visiting department

Breast center

Multiple groups

Postpartum women aged 40-50

Common locations

breast

Common symptoms

Nipple discharge, breast lump

Etiology of ductal papilloma in the breast

The etiology is not clear, and most scholars believe that it is mainly related to increased or relatively increased estrogen levels. Due to the excessive stimulation of estrogen, the ducts dilate, and the epithelial cells proliferate, forming a papillary tumor in the duct.

Clinical manifestations of intraductal papilloma of the breast

Nipple discharge

There is bloody, serous, or serous discharge from the nipple. The discharge can be continuous or intermittent. Some patients exudate fluid when squeezing the breast, while others inadvertently find stains on their underwear or bra. Individual patients may experience pain or inflammation. Intraductal papilloma is more susceptible to nipple discharge, while peripheral type papillomas rarely show discharge.

2. breast lump

Due to the small size of the papilloma in the duct of the mammary gland, the mass cannot be detected by clinical examination in most cases. Some central papillomas can feel nodular or cord-like masses near the areola. The texture is soft and the fluid can be discharged when the mass is lightly pressed. Peripheral papillomas occur in the quadrant around the mammary gland, and if the mass can be touched, they can be around the breast.

Intraductal papilloma of the breast

1. ductoscopy

A fiberoptic tubescope is placed from the mouth of the milk duct, and the condition of the epithelium and lumen of the milk duct can be directly observed through the TV screen. Biopsy can be performed as appropriate, which greatly improves the papilloma in the duct The diagnostic accuracy provides accurate tumor location for patients who need surgery.

2. Breast ductography

Mammary ductal angiography is a radiograph after the contrast agent is injected into the overflow catheter. The papilloma in the mammary ducts shows a sudden interruption of the catheter, a curved cup-shaped image of the broken end, a smooth and complete tube wall, and round or oval filling defects. The proximal catheter showed significant dilation. Because breast angiography cannot directly observe the lesions in the ductal epithelium and the catheter lumen, many large hospitals are no longer using them, and the diagnosis of intraductal lesions is usually performed by endoscopy.

3. Breast ultrasound

Dilated ducts and tumor images can be seen on larger intraductal papilloma color Doppler ultrasound.

4. Exfoliation cytology or needle aspiration cytology

Nipple discharge cytology smear examination is made by collecting nipple discharge, making a cytology smear, and observing through a microscope to understand the cytological characteristics of the lesion. If tumor cells can be found, a clear diagnosis can be made. The positive rate is low but repeatable. Yes, clinicians should objectively analyze the smear results. Needle aspiration cytology can be performed in cases where the mass can be felt on examination. The final diagnosis should be based on paraffin sections (histological diagnosis).

Diagnosis of intraductal papilloma of the breast

Middle-aged and elderly women often have bloody discharge in their nipples, or stains of bloody discharge are found on underwear and bras; bumps below 1cm can be touched in the areola, and they are soft. Pressing the bumps can lead to discharge. Those with the above clinical manifestations may consider the possibility of suffering from intraductal papilloma of the breast. You can choose to confirm the diagnosis by using bronchoscopy, mammography, color Doppler ultrasound, cytology smear of nipple discharge, needle aspiration or surgical biopsy.

Differential diagnosis of ductal papilloma in the breast

Because the main clinical manifestation of intraductal papilloma is nipple discharge, it should be differentiated from breast diseases that produce nipple discharge, such as intraductal papillary carcinoma, mammary duct dilatation, and breast cystic hyperplasia.

1. Differentiation from intraductal papillary carcinoma of the breast

Intraductal papillary carcinoma of the breast is classified as ductal carcinoma in situ and occurs in the ducts of the breast. Intraductal papillary carcinoma is mainly bloody discharge, mostly unilateral and single-hole discharge. If the ductal papillary cancer can reach the mass, it is mostly located outside the areola area, the texture is hard, the surface is not smooth, the mobility is poor, the mass is often larger than 1cm, and the ipsilateral axillary lymph nodes are enlarged. The auxiliary examination can be distinguished from the intraductal papilloma, and the clear diagnosis should be based on the pathological examination.

2. Differentiation from breast duct dilatation

Breast duct dilatation is a chronic benign disease that can last for months or years. After a long period of onset, the milk duct secretion not only stimulates the dilation of the catheter, but also overflows the tube, causing an inflammatory response mainly based on plasma cell infiltration around the tube, so it is also called plasma cell mastitis. The authors repeatedly report the condition of breast duct dilatation. One or more masses with unclear borders may appear in the areola area. The location is the same as the ductal papilloma but the mass is larger and the texture is firm. Cellulite changes, nipple retraction and even breast deformation, armpits can touch enlarged lymph nodes. Mammography can show that the large catheter is significantly dilated and tortuous, and the normal dendritic image is lost.

3. Differentiation from breast cystic hyperplasia

Cystic hyperplasia of the breast is a cyst that is highly dilated in the lobules, small ducts, and peripheral ducts of the breast, and is accompanied by other poor structures. It differs from simple hyperplasia in that it is accompanied by atypical hyperplasia. Nipple discharge in breast cystic hyperplasia can be unilateral or bilateral, mostly serous or serous, and there are fewer pure blood. Cystic hyperplasia of the breast is often treated with unilateral or bilateral breast masses. The mass is large, and it can affect most breasts, mostly near the edge of the breast. It can be an isolated sphere or a multiple cystic mass. Cystic hyperplasia of the breast often occurs with periodic pain. The pain is related to menstruation. It increases before menstruation, and the cystic mass appears to increase. After menstruation, the pain decreases and the mass shrinks. Auxiliary examinations can also help distinguish them from intraductal papilloma.

Intraductal papilloma treatment in the breast

The most effective treatment for intraductal papilloma of the breast is surgical resection. For those who can touch the mass during the clinical examination, the diseased catheter can be removed by surgical resection. For patients who cannot detect the mass during clinical examination, the lesion must be positioned before surgery. For example, the position can be marked on the skin by using laparoscopy before surgery. If necessary, a "metal positioning line" can be placed during the laparoscopy. Intraoperative guidance is used to remove the lesion; secondly, a probe or blue dye (methylene blue) is placed in the opening of the milk duct during the operation, and the probe or blue-stained area is used to guide the removal of the lesion for inspection. Patients who rely on positioning during surgery should be instructed not to squeeze the breast before surgery, so as to avoid drainage, which makes it difficult to locate during surgery. The scope of surgical removal of central ductal papilloma is reasonable and rarely recurrent; however, it can recur in other ducts on the ipsilateral breast or on the contralateral breast. For peripheral intraductal papilloma, if the surgical resection is not complete, it may lead to tumor resurgence. The glandular lobe where the lesion is located should be removed during surgery, and it should be reviewed regularly after surgery. For patients with a wide range of lesions and pathological examination suggesting atypical hyperplasia, if the patient is older, a simple mastectomy plus immediate breast reconstruction surgery may also be considered.

Prevention of intraductal papilloma of the breast

The cause of papilloma in the duct of the mammary gland is not very clear, so there is no effective preventive measure at present, self-examination of the breast (self-examination) combined with regular physical examination is recommended. Breast self-examination can promptly find abnormalities in the breast such as nipple discharge and nodules. Breast self-examination should be performed once a month, and the best time should be after menstruation or between menstruations. At this time, the breasts are soft, without pain, and it is easy to find abnormalities. For women who have stopped menstruating, they can choose a fixed time every month. Self-examination.

Breast self-examination method Standing or sitting in front of the mirror, face the mirror and carefully observe the breasts on both sides, including changes in breast size, shape, contour, skin and color, and whether the nipples are elevated, retracted, and overflowed. When palpation, spread your fingers together and touch the ventral side of your breast with your fingers. Check the right side with your left hand and the left side with your right hand. Touch clockwise or counterclockwise to avoid missing nipples, areola, and axillary areas.