Intraductal Papilloma: What Does This Biopsy Result Mean?

An intraductal papilloma is a small, benign (non-cancerous) growth inside one of the milk ducts of the breast. It is often found close to the nipple and can cause clear or bloody nipple discharge or a small lump. A biopsy result that says intraductal papilloma means the tissue sample showed this benign growth, not breast cancer.

The US National Cancer Institute describes these as wart-like growths in a breast duct. MedlinePlus says they are most common in women from their mid-30s to mid-50s. Breast Cancer Now notes that men can have them too, but very rarely.

This guide explains a result you have already received. It cannot interpret your own report or tell you which treatment is right for you; your breast care team does that.

Breast changes rarely need emergency care, but they should not wait for a routine appointment months away. The NHS says nipple discharge may not be anything serious, but it is important to get it checked, because it can sometimes be a sign of breast cancer. MedlinePlus advises contacting a provider about any breast discharge or breast lump.

Contact your doctor or breast clinic promptly if you notice:

• New or continuing nipple discharge, especially if it is bloody or comes from one breast.
• A new lump, or a lump that changes after your biopsy or treatment.
• Any other new change in the breast or nipple, even if an earlier result was benign.
• Bleeding, increasing pain, redness or signs of infection after a biopsy or operation. Follow the aftercare advice your team gave you, and use local urgent services if you feel very unwell.

The growth sits inside a duct that carries fluid to the nipple. The American Cancer Society describes papillomas as a common cause of clear or bloody discharge, especially from one breast. Cleveland Clinic notes that discharge usually comes from only one breast.

Not every papilloma causes discharge. The National Cancer Institute explains that a single papilloma is usually near the nipple and may cause a lump, pain or discharge. Multiple papillomas are usually smaller, farther from the nipple, often cannot be felt and may cause no discharge at all. Some papillomas cause no symptoms and are first seen as an abnormal area on a mammogram or ultrasound.

Mammograms and ultrasound can show an abnormal area, but Cleveland Clinic explains that a biopsy is needed to diagnose a papilloma. A pathologist looks at the tissue under a microscope. Breast Cancer Now lists core biopsy and vacuum-assisted biopsy among the tests a breast clinic may use.

When you read the report, look for these points, and ask your team to explain each one:

• Whether the papilloma is described as single (solitary) or multiple.
• Whether atypical cells (atypia, such as atypical hyperplasia) were seen. Atypia means abnormal-looking cells that are not cancer.
• Whether the biopsy sample matched what was seen on imaging, and whether the team considers the sample enough to be confident.
• Any other changes in the sample, and whether further tissue is advised.

A papilloma is not cancer. The American Cancer Society and the National Cancer Institute say that a single papilloma, without other breast changes, does not raise breast cancer risk. Multiple papillomas may slightly increase risk.

Risk can also be higher when the papilloma contains atypical hyperplasia or other changes. MedlinePlus adds that risk may be higher with papillomas at a young age or a family history of cancer. MedlinePlus describes the outlook for a single papilloma as excellent. Having a higher-risk finding does not mean cancer will develop; it may mean a different follow-up or screening plan.

Both approaches are used. MedlinePlus states that after a needle biopsy confirms an intraductal papilloma, it may be surgically removed or monitored with periodic exams and imaging. The American Cancer Society says not all papillomas need treatment, and the decision depends on size, how many there are, whether atypia is present and whether symptoms are bothersome.

Cleveland Clinic says small solitary papillomas without symptoms may be monitored with imaging. It says solitary papillomas should be removed if they contain atypical cells or cause symptoms, and that multiple papillomas generally need removal. Breast Cancer Now notes that papillomas are often removed in practice.

Removal options described by these sources include vacuum-assisted excision, which removes tissue through a needle with suction, and an excision biopsy, an operation that removes the papilloma, sometimes with the part of the duct it sits in. If discharge continues, Breast Cancer Now says the affected duct or ducts may be removed. Your team will explain which option fits your result and why.

Breast Cancer Now says that after a single papilloma is removed, routine clinic follow-up is not usually needed, although a check of wound healing may be. Follow-up is more likely after multiple papillomas or papillomas with atypical cells. Cleveland Clinic notes ongoing screening may be advised, especially with multiple papillomas.

If you are being monitored, confirm when the next imaging is due, who arranges it and how results reach you. Keep reporting new changes in between, rather than waiting for the planned scan.

Bring your imaging and pathology reports. These questions can help you leave the appointment with a clear plan:

• Was this a single papilloma or more than one?
• Did the biopsy show atypia or any other change?
• Why do you recommend removal or monitoring in my case?
• If removal is advised, which method, and what will the final pathology tell us?
• If monitoring is advised, when is the next scan and who books it?
• Does this result change my routine breast screening?
• Which new symptoms should make me contact you before the next appointment?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with a papilloma result described their pathology wording, the options they were offered and the questions they asked can help you write your own list before an appointment.

Other people's cases cannot tell you what your result means or what will happen to you. We suggest using them only to prepare questions, and to discuss decisions with your own breast care team.