To investigate the therapeutic effect of three surgical methods(mass excision, segmental excision and lobectomy) on breast intraductal papilloma and analyze risk factors of recurrence.

The clinical data of 279 patients with breast intraductal papilloma in the Taiyuan Central Hospital from January 2010 to December 2014 were retrospectively analyzed. The intraoperative and postoperative conditions of patients receiving different surgeries were compared and risk factors of recurrence were analyzed. Measurement data (operation time, intraoperative blood loss, length of hospital stay, operation cost) were compared by univariate analysis of variance. Count data (paresthesia of nipple area, etc.) were compared by χ² test. Rank data (appearance satisfaction) were compared by Kruskal-Wallis H test. Multivariate analysis was performed by logistic regression analysis.

There was a significant difference in operation cost among three surgical methods [mass excision(n=108): (840.9±361.7) yuan; segmental excision(n=96): (1 840.8±473.6) yuan; lobectomy(n=75): (1 761.2±370.5) yuan; F=969.65, P<0.001]. The operation time, intraoperative blood loss and length of hospital stay presented no significant difference among three groups (F=2.88, 2.40, 2.54; P=0.058, 0.092, 0.081). No significant difference was observed in paresthesia of nipple area and appearance satisfaction among three groups(χ²=1.77, 1.83; P=0.430, 0.400). Univariate analysis showed that age, concurrent atypical hyperplasia, tumor diameter, surgical method and tumor type were related to postoperative recurrence(χ²=3.98, 6.68, 8.56, 21.34, 20.24; P=0.046, 0.010, 0.003, <0.001, <0.001). Logistic regression analysis showed that risk factors of postoperative recurrence included age ≥ 45 years, concurrent atypical hyperplasia, tumor diameter ≥ 1 cm, peripheral papilloma(OR=2.27, 95%CI: 1.00-5.12, P=0.048; OR=4.73, 95%CI: 2.07-10.78, P<0.001; OR=2.17, 95%CI: 1.03-4.56, P=0.040; OR=3.13, 95%CI: 1.25-7.82, P=0.015) and surgical method(compared with lobectomy, the recurrence risk of lumpectomy was 2.65 times as high as that of lobectomy, segmentectomy 2.17 times). Stratified analysis by tumor type showed that for patients with central papilloma, age ≥ 45 years, concurrent atypical hyperplasia and tumor diameter ≥ 1 cm were risk factors of recurrence(OR=2.83, 95%CI: 1.44-5.58, P=0.003; OR=2.09, 95%CI: 1.03-4.26, P=0.040; OR=3.29, 95%CI: 1.02-10.61, P=0.047); for patients with peripheral papilloma, the risk factors of recurrence were age ≥ 45 years, concurrent atypical hyperplasia, tumor diameter ≥ 1 cm, tumor resection and segmental resection(OR=4.78, 95%CI: 1.26~18.16, P=0.022; OR=3.84, 95%CI: 1.19~12.39, P=0.025; OR=1.82, 95%CI: 1.03~3.19, P=0.038; OR=2.36, 95%CI: 1.17~4.76, P=0.016; OR=2.64, 95%CI: 1.38~2.05, P=0.003).

Age, concurrent atypical hyperplasia, surgical method, tumor diameter and tumor type are risk factors of recurrence in patients with intraductal papilloma. Breast lobectomy can effectively reduce postoperative recurrence of peripheral papilloma, worthy of clinical application.