Abstract
BackgroundSubjective qualitative descriptors are sometimes used to describe atypical breast lesions diagnosed on core needle biopsy (CNB) which are limited in extent. In clinical practice, this terminology is used to imply a lower expected risk of upgrade on surgical excision (EXC). It is uncertain how subjective terminology impacts clinical management.MethodsWe conducted a retrospective review of CNB with atypia and compared the EXC and upgrade rates of atypical ductal hyperplasia (ADH) and flat epithelial atypia (FEA) to lesions described as “focal” atypical ductal hyperplasia (FADH), to determine the impact of this diagnostic phrasing on surgical management and risk of malignancy.ResultsFADH and ADH were excised at similar rates (82% vs. 78%). FADH lesions showed a similar upgrade rate (13%) compared to non-focal ADH (10%), and both showed a trend towards higher upgrade and EXC rates compared to FEA. ADH, FADH and FEA all had an upgrade risk that warranted EXC. In non-upgraded EXC, for each diagnostic category we observed similar rates of residual atypia in the EXC.ConclusionsPathologists should avoid the use of qualitative descriptors when describing ADH on CNB because of the potential of this terminology to influence clinical decision making which is unwarranted.
Highlights
Subjective qualitative descriptors are sometimes used to describe atypical breast lesions diagnosed on core needle biopsy (CNB) which are limited in extent
Patients with Atypical ductal hyperplasia (ADH) identified on needle core biopsy (CNB) have an increased risk for the subsequent development of both ductal carcinoma in situ (DCIS) and invasive breast carcinoma [1,2,3,4]
We examined the impact of the use of the diagnosis focal” atypical ductal hyperplasia (FADH) on rate of EXC and compared the upgrade rate of FADH to ADH and flat epithelial atypia (FEA)
Summary
Subjective qualitative descriptors are sometimes used to describe atypical breast lesions diagnosed on core needle biopsy (CNB) which are limited in extent. In clinical practice, this terminology is used to imply a lower expected risk of upgrade on surgical excision (EXC). Patients with ADH identified on needle core biopsy (CNB) have an increased risk for the subsequent development of both DCIS and invasive breast carcinoma [1,2,3,4]. Patients with ADH as the most significant finding after EXC may be offered anti-endocrine chemopreventive therapy to reduce the risk of subsequent invasive and non-invasive breast cancer [17, 18]. Due to the morbidity associated with surgical intervention and anti-endocrine treatment, the accuracy of the diagnosis of ADH on CNB is critical
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