Factors in the Breast Core Needle Biopsies of Atypical Ductal Hyperplasia that Can Predict Carcinoma in the Subsequent Surgical Excision Specimens

Abstract

Breast core needle biopsy (CNB) is an established method for diagnosing benign and malignant breast disease and CNB is widely used in daily practice. However, CNB samples only part of a lesion, and this can be the reason for an inaccurate diagnosis.(1) This size limitation of CNB gives rise to important diagnostic problems because one of the important factors for making the differential diagnosis between atypical ductal hyperplasia (ADH) and lowgrade ductal carcinoma in situ (DCIS) is the size of the lesion.(2,3) Previous studies have reported that ADH in a CNB showed significant discordance in the subsequent surgical excision specimens for which 33-87% demonstrated ductal carcinoma such as DCIS and invasive ductal carcinoma (IDC).(4-11) Therefore, surgical excision is presently recommended when ADH is diagnosed in a CNB. Investigations to determine the factors that are predictive of more advanced lesions in surgical excision specimens when ADH was diagnosed in the CNB have suggested cytologic atypia,(11) more than 4 foci (7) and micropapillary architecture (7), yet consistent results were not demonstrated. The purpose of this study was to identify the predictive factors that suggest the diagnosis of ductal carcinoma in the subsequent surgical excision specimens when ADH is diagnosed in a CNB.