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

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.

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.