The Incidence of Adjacent Synchronous Ipsilateral Infiltrating Carcinoma and/or DCIS in Patients Diagnosed With Intraductal Papilloma Without Atypia or Flat Epithelial Atypia by Core Needle Biopsy

  • End date
    Jun 22, 2023
  • participants needed
  • sponsor
    Dana-Farber Cancer Institute
Updated on 22 July 2021


This research study is studying a surgical intervention to rule out the presence of cancer in participants that have been diagnosed with flat epithelial atypia (FEA) or intraductal papilloma without atypia (IPWA) by core needle biopsy.


Breast milk is made in lobules and is carried through the ducts toward the nipple. Normal ducts are lined by one layer of cells very similar to each other in appearance. Flat epithelia atypia (FEA) and intraductal papilloma without atypia (IPWA) are changes seen within the milk ducts. In the recent years these lesions have been seen more often, seemingly because more core needle biopsies are being done with the help of a mammogram, ultrasound or breast MRI. The reason for this is there is new technology available which is able to do such biopsies. A core needle biopsy uses a hollow needle to remove samples of tissue from the breast. This is an accurate method that does not involve surgery.

FEA and IPWA are not very common and there are few research studies addressing them. Women found to have FEA or IPWA on core biopsy results may receive conflicting recommendations about how to precede next. It is unclear if more tissue should be removed from the biopsy site to ensure that there is no cancer nearby.

The purpose of this study is to find out how often cancer is identified by excisional biopsy near an initial core biopsy where FEA or IPWA has previously been seen. Depending on these findings doctors will be better able to advise their patients as to whether they need to have a surgical biopsy, when FEA or IPWA are seen on needle biopsy, to rule out the presence of breast cancer.

Condition Flat Epithelia Atypia, Intraductal Papilloma Without Atypia
Treatment Pathologic evaluation of excised tissue
Clinical Study IdentifierNCT02489617
SponsorDana-Farber Cancer Institute
Last Modified on22 July 2021


Yes No Not Sure

Inclusion Criteria

Women all races and ethnic groups are eligible for this trial. This trial is open to the accrual of women only
Patients must be women
Patients must be at least 18 years of age
Patients must have an imaging abnormality that necessitated a core needle biopsy
The imaging abnormality must have been categorized as Breast Imaging-Reporting and Data System (BIRADS) level 1-4 lesion
There is documented concordance between the initial breast imaging finding and the core biopsy pathology report. The core needle biopsy must contain FEA or IPWA, according to the local pathologist. (It is possible that the central pathology review which is done after the patient is registered on this protocol will have a diagnosis discrepant from that made by the original institution's pathologist. In that case, the study team will communicate this to the original institution's site investigator within one week of the date of the central pathology review having been finalized). Patients may have a personal history of prior or concurrent fibroadenoma and a prior history of proliferative breast lesions with or without atypia
Patients must be registered on study within 100 days after core needle biopsy
Patients must have an ability to understand and the willingness to sign a written informed consent document. The patient is still eligible for this study even if she declines consent for her tissue to be used for any (or all) of the correlative studies described in this document and/or if she declines consent for her tissue to go into a tissue bank for future unspecified research
Concordance is a determination by the radiologist (or his or her covering provider) performing an image-guided core needle biopsy that the pathology report from this procedure corresponds to the imaging appearance of a given lesion and that the said lesion's most representative portion has been sampled

Exclusion Criteria

Personal history and/or concomitant diagnosis of invasive breast cancer or DCIS
Palpable abnormality diagnosed by core needle biopsy to be FEA or IPWA
Pathologic nipple discharge associated with IPWA (spontaneous bloody or clear persistent single duct discharge)
A BIRADS 5 lesion
Discordance between the initial breast imaging finding and the core biopsy pathology report
The presence of atypical ductal hyperplasia (ADH) on core biopsy
Known current pregnancy. A pregnancy test is not required for this exclusion criteria
Women who are breastfeeding
Patient registered on study more than 100 days since the date of core needle biopsy
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