A1 Refereed original research article in a scientific journal
Upgrade risk in intraductal papillomas: A retrospective analysis of real-world data and predictive model development
Authors: Kotola, Jenni; Tamminen, Anselm
Publisher: Elsevier BV
Publication year: 2026
Journal: Human Pathology
Article number: 106097
Volume: 172
ISSN: 0046-8177
eISSN: 1532-8392
DOI: https://doi.org/10.1016/j.humpath.2026.106097
Publication's open availability at the time of reporting: Open Access
Publication channel's open availability : Partially Open Access publication channel
Web address : https://doi.org/10.1016/j.humpath.2026.106097
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/515864545
Self-archived copy's licence: CC BY
Self-archived copy's version: Publisher`s PDF
BackgroundIn current practice, the traditional strategy of excising all IDPs has been replaced by more selective management. However, criteria for selecting patients for surveillance remain unclear, and no widely accepted predictive model exists.MethodsWe retrospectively analyzed real-world data from 325 cases of IDPs diagnosed via core needle biopsy (CNB) at a tertiary teaching hospital between 2010 and 2023. We assessed upgrade rates to malignancy and evaluated potential predictive factors. Two previously published models were applied to our cohort, and a new model was developed based on our data.ResultsOverall, 17% (55/325) of IDPs were upgraded to malignancy. Among lesions without atypia on CNB (n = 215), the upgrade rate was 8.8% (19/215), compared to 40% (23/58) in those with atypia (p < 0.001). Previously suggested models yielded modest results when applied to our study population. First model would have spared 11% (24/215) of patients from surgery, while the second model would have spared 17% (36/215), with one missed upgrade. Our model identified all upgraded cases and would have spared 33% (72/215) of non-atypical IDPs from surgery.ConclusionsAtypia on CNB is a strong predictor of upgrade to malignancy. Existing models showed limited utility in reducing unnecessary surgeries. Our proposed model demonstrated improved performance and may support more individualized management of IDPs.
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Funding information in the publication:
This study was supported by grant from the Clinical Research Track of University of Turku, Faculty of Medicine. The funding sources had no role in the design, conduction, analysis or reporting of the study.
