Excisional biopsy or surveillance for introductal papilloma?

PluggingThrough

Hi everyone,

I was recently diagnosed with an introductal papilloma, .9 cm, no atypical cells. I met with a nurse practitioner today who told me they could do an excisional biopsy or just do a mammogram and ultrasound every 3 mos for three years. She told me it was my choice, but her surgeon usually recommends surveillance unless the patient "really wants it out." she also said that that particular surgeon does these very infrequently and seemed to be in favor of surveillance. This advice seems to contradict what I've read here and elsewhere online. any advice?

MelissaDallas

Here is a recent study and discussion on that question.

http://www.cinj.org/sites/cinj/files/documents/MgmtBenignIntraductalPapilloma.pdf

PluggingThrough

Than you!

MelissaDallas

Pretty interesting. I always wondered why it seemed they almost always did the duct excision when there is such a low incidence of associated cancer. I don't know what would be the bigger pain in the butt though...having to have twelve follow ups or just getting the very minor excision done-maybe by a breast surgeon who dooes them frequently. I do like conservative-approach doctors myself. Not everyone does

alicki

Hello

Sorry but mammograms every theee months???

That's crazy radiation

Best wishes

Alicki

MelissaDallas

I believe it would be some combo of mammograms & ultrasounds, with mammo only once or twice a year-not quarterly mammogram

PluggingThrough

Thanks, all. It's possible I misunderstood and the NP meant that I would have ultrasounds every three months (although I really thought she said both). The way she described the incision did not seem minor to me. She said the surgeon, who she admitted does these infrequently, would take about 2 cm of tissue surrounding the mass. The mass is 1 cm, so I'm assuming this means she will take a 5 cm chunk of tissue out! She also said I could have a misshapen breast and an inverted nipple but could not tell me the chances of that occurring. I think I'm going to get a second opinion. I'd like to speak to an actual surgeon. Would it be silly to see a breast surgical oncologist instead of just a breast surgeon? That was recommended on the Johns Hopkins ask a doctor site. Thx for the feedback

PluggingThrough

Melissa, I think there is u/s and mammo follow up for three yrs even after the excision. The NP said it was the same frequency unless I misunderstood her. The more I think about it, the more I think she was promoting the surveillance option. Oddly, she said that another surgeon in their practice excises all of them. It seems strangethat they would have such extreme differences of opinion in the same practice.

MelissaDallas

I'd go to another practice for a second opinion-as far as whether it needs to be a surgical oncologist, that wouldn't be silly. Technically, there is no "board specialty" for breast surgeons-they are general surgeons specializing in the breast. Where do you live? I would go to a breast clinic at an NCI cancer center or major university hospital if possible. I think your follow up would depend on the findings on the excisional biopsy. If it had no associated atypia and was purely benign I wouldn't think it would be quarterly for that long, but I'm no expert on that.Apparently you aren't experiencing symptoms, but papillomas can be a hassle because they can grow & sometimes cause bloody discharge from that duct.

PluggingThrough

Melissa, you are right, I am asymtomatic. Although I noticed that the nipple on that side looks different and I asked the NP about and she said it's not concerning since the other one has it too (but to a much lesser degree). But that's another topic! I live in Boston and have already decided to go to another specialist. I have some names of several good surgical oncologists at the main cancer center here (Dana Farber). Thx for your input, it's very helpful. I'm still curious as to whether others on this board with an introductal papilloma and no atypical cells have chosen excision.

Jones777

Hi Plugging...

My BS removes everything. I guess she had one incidence where she was 100% sure a lump was not cancer and it turned out to be. So I go in knowing if she finds anything- I will end up having it removed. Which is honestly okay by me. I want it gone