Papillary lesions of the breast represent a heterogeneous group of neoplasms sharing many morphologic similarities. These lesions may demonstrate overlapping clinical and radiologic features but may have diverse clinical outcomes. Our state-of-the-art knowledge has led to outcome-based reclassification of some of these entities. Further studies are needed to elucidate the pathogenesis and, more importantly, to seek potential decision tools in stratifying these lesions given the divergent approaches currently used.