Differentiating Benign from Malignant Papillary Breast Lesions: Insights from a Multi-Modality Imaging Approach

Sayed Abul Khair, Syarifah Muna-Izzati; Ramli Hamid, Marlina Tanty; Teoh, Kean Hooi; Fadzli, Farhana; Nawawi, Ouzreiah; Mohd Ramli, Norlisah; Rozalli, Faizatul Izza; See, Mee Hoong; Rahmat, Kartini

doi:10.30476/mejc.2026.106143.2257

Differentiating Benign from Malignant Papillary Breast Lesions: Insights from a Multi-Modality Imaging Approach

Document Type : Original Article(s)

Authors

Syarifah Muna-Izzati Sayed Abul Khair ¹

Marlina Tanty Ramli Hamid ²

Kean Hooi Teoh ³

Farhana Fadzli ¹

Ouzreiah Nawawi ¹

Norlisah Mohd Ramli ¹

Faizatul Izza Rozalli ¹

Mee Hoong See ⁴

Kartini Rahmat ¹

¹ Department of Biomedical Imaging, University Malaya Research Imaging Centre, Kuala Lumpur, Malaysia

² Department of Radiology, Faculty of Medicine Universiti Teknologi MARA, Selangor, Malaysia

³ Department of Pathology, University Malaya Medical Centre, Kuala Lumpur, Malaysia

⁴ Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia

https://doi.org/10.30476/mejc.2026.106143.2257

Abstract

Background: Papillary breast lesions are a heterogeneous group of breast lesions with overlapping benign and malignant imaging features, often posing diagnostic and management challenges. The present study aimed to evaluate the imaging characteristics of papillary breast lesions using ultrasound (US), mammography, and magnetic resonance imaging (MRI), and to correlate these findings with histopathological results to identify features predictive of malignancy.
Method: In this retrospective observational study, we reviewed clinical, imaging, and pathological data from 168 women with 188 histologically confirmed papillary breast lesions treated at a tertiary center from 2009 to 2019. Imaging features were assessed using the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) lexicon. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY). Mann–Whitney U test and Pearson chi-squared test were used to investigate group differences, and binary logistic regression was applied to evaluate associations. A P <0.05 was considered statistically significant.
Results: Malignant lesions were significantly larger in size (median >10 mm, P < 0.001), and more likely to exhibit non-circumscribed margins, internal vascularity, posterior acoustic features, and non-parallel orientation on US. Mammographic features significantly associated with malignancy included irregular shape and non-circumscribed margins (P < 0.05). MRI features predictive of malignancy included irregular shape, non-circumscribed margins, heterogeneous enhancement, and non-mass enhancement, although the small MRI sample size limits the generalizability of the study results.
Conclusion: Specific imaging features on US, mammography, and MRI may help distinguish malignant from benign papillary breast lesions. Given the notable upgrade rate upon excision, surgical removal is recommended for lesions with atypical or indeterminate features.

Highlights

Marlina Tanty Ramli Hamid (google scholar)

Keywords

Breast neoplasms

Biopsy

Diagnostic imaging

Magnetic resonance imaging

Mammography

Subjects

Cancer Imaging and non-surgical Interventions

How to cite this article:

Sayed Abul Khair SMI, Ramli Hamid MT, Teoh KH, Fadzli F, Nawawi O, Mohd Ramli N, et al. Differentiating benign from malignant papillary breast lesions: Insights from a multi-modality imaging approach. Middle East J Cancer. 2026; 17(3): 260-71. doi: 10.30476 /mejc.2026.106143.2257.

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