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Papillary neoplasms of the breast encompass a broad spectrum of lesions that remain one of the most challenging topics in breast pathology. Although recognizing the papillary architecture is straightforward, classification into in situ and invasive can be problematic due to the overlapping features among these lesions. This review focuses on diagnosing and classifying the papillary neoplasm with an update from the WHO 5th edition and current opinion on clinical management.