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Clinicopathological features and impact on surgical axillary management of encapsulated papillary carcinoma of the breast
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DOI：10.1007/s12672-026-05609-6.png)
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Abstract
En 中文
Encapsulated papillary carcinoma (EPC) is a rare breast malignancy accounting for approximately 0.5–1% of all breast cancers. Although generally associated with favorable outcomes, the presence of invasive carcinoma may influence axillary nodal involvement, treatment decisions, and prognosis. To evaluate the clinicopathological and imaging characteristics of EPC, assess the frequency of associated invasive disease and axillary lymph node involvement, and determine their impact on surgical axillary management and oncological outcomes. This retrospective cohort study included all consecutive patients diagnosed with EPC and treated surgically at Baheya Center for Early Detection and Treatment of Breast Cancer, Egypt, between 2017 and 2024. Clinical, radiological, pathological, treatment, and follow-up data were reviewed. Patients were classified as pure EPC, EPC associated with ductal carcinoma in situ (DCIS), or invasive EPC. Survival outcomes were analyzed using the Kaplan–Meier method. A total of 113 patients with EPC were included. Histopathological evaluation demonstrated pure EPC in 22 patients (19%), EPC associated with DCIS in 17 (15%), and invasive EPC in 74 (65%). Most patients were postmenopausal, and the majority of tumors exhibited favorable biological characteristics, including high hormone receptor positivity and low HER2 expression. Axillary metastases were identified in 15 patients (13.2%) and occurred exclusively in tumors associated with invasion. Sentinel lymph node biopsy was performed in 82 patients (72.5%), axillary dissection in 11 (9.7%), and no axillary surgery in 20 (17.6%). Invasive EPC was associated with larger tumor size, higher pathological stage, and increased nodal involvement compared with non-invasive EPC. During follow-up, loco-regional recurrence occurred in four patients and distant metastases in three patients, all within the invasive EPC subgroup. Kaplan–Meier analysis demonstrated excellent overall and disease-free survival. EPC is an uncommon breast malignancy with an overall favorable prognosis, but it remains a diagnostically and therapeutically challenging entity because of its heterogeneous pathological spectrum and the variable presence of associated invasive carcinoma. It needs individualized axillary management, with routine axillary staging potentially unnecessary in carefully selected patients with pure EPC, while invasive EPC warrants more comprehensive surgical assessment.
Keywords:
Encapsulated papillary carcinoma
Breast cancer
Axillary lymph node metastasis
Sentinel lymph node biopsy
Invasive carcinoma
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