Intraductal papilloma

Last updated: November 22, 2022

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Intraductal papilloma is a tumor that arises from the epithelium of the lactiferous ducts, with a peak incidence between 30–50 years of age. Solitary papillomas (central papillomas) are the most common cause of bloody or serous nipple discharge and are often associated with a palpable retroareolar mass; they are typically benign. Multiple papillomas (peripheral papillomas) are usually asymptomatic and diagnosed incidentally; they are often associated with atypia, DCIS, or invasive breast cancer. Characteristic features of intraductal papillomas on age-appropriate breast imaging include a well-defined intraductal mass and calcifications. Image-guided core needle biopsy is recommended in all patients for diagnostic confirmation and to assess for cellular atypia. Intraductal papillomas without atypia can be managed expectantly. Surgical excision to rule out concomitant malignancy is recommended for patients with intraductal papillomas with atypia; these patients should undergo further risk assessment for breast cancer and be considered for prophylactic chemotherapy.

Epidemiological data refers to the US, unless otherwise specified.

  • Solitary papilloma (also known as central papilloma)
  • Multiple papillomas (also known as peripheral papillomas)

Solitary intraductal papillomas are typically benign. Multiple papillomas are often associated with atypia, DCIS, or invasive breast cancer. [1][4]

Follow age-appropriate diagnostic workup for a palpable breast mass and/or nipple discharge (see “Breast mass” and “Nipple discharge” for details). The findings specific to intraductal papillomas are described here. Asymptomatic intraductal papillomas may also be detected incidentally.


Initial imaging [1][4][5]

Additional imaging


Breast MRI [4][9]

Core needle biopsy [4]

  • Intraductal papilloma without atypia [4][9][12][13]
    • Surveillance
    • Excision may be considered for symptomatic control.
  • Intraductal papilloma with atypia [4][14]
    • Surgical excision of the affected duct(s)
    • Refer patients to oncology for further risk assessment and the possible need for prophylactic chemotherapy.
  • Intraductal papilloma without atypia: good prognosis
  • Intraductal papillomas with atypia: associated with an increased risk of breast cancer
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  3. Ghosh AK. Mayo Clinic Internal Medicine Board Review. Oxford University Press ; 2010
  4. Calvillo KZ, Portnow LH. Intraductal papillomas of the breast. Ann Breast Surg. 2021; 5 : p.24-24. doi: 10.21037/abs-20-113 . | Open in Read by QxMD
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  7. ACR Appropriateness Criteria® Evaluation of Nipple Discharge.
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  9. Lee SJ, Wahab RA, Sobel LD, et al. Analysis of 612 Benign Papillomas Diagnosed at Core Biopsy: Rate of Upgrade to Malignancy, Factors Associated With Upgrade, and a Proposal for Selective Surgical Excision. AJR Am J Roentgenol. 2021; 217 (6): p.1299-1311. doi: 10.2214/ajr.21.25832 . | Open in Read by QxMD
  10. Tay TKY, Tan PH. Papillary neoplasms of the breast—reviewing the spectrum. Mod Pathol. 2021; 34 (6): p.1044-1061. doi: 10.1038/s41379-020-00732-3 . | Open in Read by QxMD
  11. Wei S. Papillary Lesions of the Breast: An Update. Arch Pathol Lab Med. 2016; 140 (7): p.628-643. doi: 10.5858/arpa.2015-0092-ra . | Open in Read by QxMD
  12. Consensus Guideline on Concordance Assessment of Image-Guided Breast Biopsies and Management of Borderline or High-Risk Lesions. Updated: November 2, 2016. Accessed: July 7, 2022.
  13. Nakhlis F, Baker GM, Pilewskie M, et al. The Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In Situ in Patients with Intraductal Papilloma without Atypia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 034). Ann Surg Oncol. 2021; 28 (5): p.2573-2578. doi: 10.1245/s10434-020-09215-w . | Open in Read by QxMD
  14. Khan S, Diaz A, Archer KJ, et al. Papillary lesions of the breast: To excise or observe?. Breast J. 2018; 24 (3): p.350-355. doi: 10.1111/tbj.12907 . | Open in Read by QxMD

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