Abstract
BackgroundRisk assessment and therapeutic options are challenges when counselling patients with an atypical ductal hyperplasia (ADH) to undergo either open surgery or follow-up only.MethodsWe retrospectively analyzed a series of ADH lesions and assessed whether the morphological parameters of the biopsy materials indicated whether the patient should undergo surgery. A total of 207 breast biopsies [56 core needle biopsies (CNBs) and 151 vacuum-assisted biopsies (VABs)] histologically diagnosed as ADH were analyzed retrospectively, together with subsequently obtained surgical specimens. All histological slides were re-analyzed with regard to the presence/absence of ADH-associated calcification, other B3 lesions (lesion of uncertain malignant potential), extent of the lesion, and the presence of multifocality.ResultsThe overall underestimation rate for the whole cohort was 39% (57% for CNB, 33% for VAB). In the univariate analysis, the method of biopsy (CNB vs VAB, p = 0.002) and presence of multifocality in VAB specimens (p = 0.0176) were significant risk factors for the underestimation of the disease (ductal carcinoma in situ or invasive cancer detected on subsequent open biopsy). In the multivariate logistic regression model, the absence of calcification (p = 0.0252) and the presence of multifocality (unifocal vs multifocal ADH, p = 0.0147) in VAB specimens were significant risk factors for underestimation.ConclusionsMultifocal ADH without associated calcification diagnosed by CNB tends to have a higher upgrade rate. Because the upgrade rate was 16.5% even in the group with the lowest risk (VAB-diagnosed unifocal ADH with calcification), we could not identify a subgroup that would not require an open biopsy.
Highlights
Atypical ductal hyperplasia (ADH) is a small, mostly unifocal, low-grade intraductal lesion in the breast, which in most cases is detected by the associated calcification seen on mammograms [1,2,3,4]
Of the patients with atypical ductal hyperplasia (ADH), 207 biopsies (151 vacuum-assisted biopsies (VABs) and 56 core needle biopsies (CNBs)) could be re-analyzed by reviewing the histological slides and classifying ADH according to the histological criteria mentioned above
To the best of our knowledge, this is the largest study to show that the biopsy method (CNB or VAB) influences the outcome determined based on surgical specimens, with a greater rate of disease upgrade after diagnosis by CNB than by VAB
Summary
Atypical ductal hyperplasia (ADH) is a small, mostly unifocal, low-grade intraductal lesion in the breast, which in most cases is detected by the associated calcification seen on mammograms [1,2,3,4]. The definition of ADH is similar to that of low-grade DCIS, and the clinical management strategy has been surgery for over 2 decades, because the risk of underestimating the disease is 20–30%, calculated from a comparison of the Breast Cancer (2019) 26:452–458 diagnosis based on needle biopsy and the subsequent analysis of surgical specimens [2, 5, 6]. The method of biopsy (CNB vs VAB, p = 0.002) and presence of multifocality in VAB specimens (p = 0.0176) were significant risk factors for the underestimation of the disease (ductal carcinoma in situ or invasive cancer detected on subsequent open biopsy). Because the upgrade rate was 16.5% even in the group with the lowest risk (VAB-diagnosed unifocal ADH with calcification), we could not identify a subgroup that would not require an open biopsy
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