Abstract

Research Article

Atypical Ductal Hyperplasia: Factors predicting upstaging to carcinoma

Kristen Elstner*, Sinem Gultekin, Wendy Vincent and Sanjay Warrier

Published: 06 July, 2020 | Volume 4 - Issue 2 | Pages: 011-017

Aim: Percutaneous core needle biopsy (CNB) is considered the gold standard technique for initial histological diagnosis of suspicious breast lesions seen on screening mammogram, but it is less reliable for diagnosing atypical ductal hyperplasia (ADH) due to significant rates of diagnosis upstaging to malignant disease after excision biopsy. The purpose of this study was to identify factors that predict diagnosis upstage to carcinoma in patients diagnosed with ADH on core biopsy.

Methods: A retrospective database search identified 52 consecutive CNB of suspicious breast lesions revealing pure ADH. Inclusion criteria included asymptomatic women presenting for screening mammogram, who subsequently underwent surgical excision. Logistic regression analysis evaluated clinical, radiological, and histological factors.

Results: A total of 52 patients with ADH on CNB were identified who met our criteria. Twenty-six of 52 patients (50%) were upstaged to ductal carcinoma in situ or invasive carcinoma, based on histological interpretation of the surgically excised specimen. Lesion size was showed to be a statistically significant predictor on univariable logistic regression analysis. Multivariate logistic regression analysis revealed Asian ethnicity and lesion size as independent predictors of malignancy (p = 0.050 and 0.011, respectively). Conversely, women of Middle Eastern and European origin and lesions < 15 mm on mammography were negative predictors of malignancy.

Conclusion: Lesion size ≥ 15 mm on mammography and Asian ethnicity are independent risk factors for breast carcinoma in asymptomatic patients diagnosed with ADH on CNB.

Read Full Article HTML DOI: 10.29328/journal.ascr.1001045 Cite this Article Read Full Article PDF

References

  1. Ancona A, Capodieci M, Galiano A, Mangieri F, Lorusso V, et al. Vacuum-assisted biopsy diagnosis of atypical ductal hyperplasia and patient management. Radiol Med. 2011; 116: 276-291. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21225358
  2. Masood S, Rosa M. Borderline breast lesions: diagnostic challenges and clinical implications. Adv Anat Pathol. 2011; 18: 190-198. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21490436
  3. Nguyen CV, Albarracin CT, Whitman GJ, Lopez A, Sneige N, et al. Atypical ductal hyperplasia in directional vacuum-assisted biopsy of breast microcalcifications: considerations for surgical excision. Ann of Surg Oncol. 2011; 18: 752-761. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20972636
  4. Dupont WD, Parl FF, Hartmann WH, Brinton LA, Winfield AC, et al. Breast cancer risk associated with proliferative breast disease and atypical hyperplasia. Cancer. 1993; 71: 1258-1265. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8435803
  5. Page DL, Dupont WD, Rogers LW, Rados MS. Atypical hyperplastic lesions of the female breast. A long-term follow-up study. Cancer. 1985; 55: 2698-2708. PubMed: https://pubmed.ncbi.nlm.nih.gov/2986821/
  6. Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast cancer. N Engl J Med. 1985; 312: 146-151. PubMed: https://pubmed.ncbi.nlm.nih.gov/3965932/
  7. Page DL, Lowell WR. Combined histologic and cytologic criteria for the diagnosis of mammary and atypical ductal hyperplasia. Hum Pathol. 1992; 23: 1095-1097. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1328030
  8. McGhan LJ, Pockaj BA, Wasif N, Giurescu ME, McCullough AE, et al. Atypical ductal hyperplasia on core biopsy: an automatic trigger for excisional biopsy? Ann Surg Oncol. 2012; 19: 3264-3269. PubMed: https://pubmed.ncbi.nlm.nih.gov/22878619/
  9. VandenBussche CJ, Khouri N, Sbaity E, Tsangaris TN, Vang R, et al. Borderline atypical ductal hyperplasia/low-grade ductal carcinoma in situ on breast needle core biopsy should be managed conservatively. Am J Surg Pathol. 2013; 37: 913-923. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23598968
  10. Sinn HP, Elsawaf Z, Helmchen B, Aulmann S. Early breast cancer precursor lesions: lessons learned from molecular and clinical studies. Breast Care. 2010; 5: 218-226. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3346166/
  11. Villa A, Tagliafico A, Chiesa F, Chiaramondia M, Friedman D, et al. Atypical ductal hyperplasia diagnosed at 11-gauge vacuum-assisted breast biopsy performed on suspicious clustered microcalcifications: could patients without residual microcalcification be managed conservatively? AJR. 2011; 197: 1012-1018. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21940593
  12. Ko E, Han W, Lee JW, Cho J, Kim EK, et al. Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy. Breast Cancer Res Treat 2008; 112: 189-195. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18060577
  13. American College of Radiology. Breast imaging reporting and data system (BI-RADS). 4th ed. Reston, VA: American College of Radiology; 2003.
  14. Polat AK, Kanbour-Shakir A, Andacoglu O,  Polat AV, Johnson R, et al. Atypical hyperplasia on core biopsy: is further surgery needed? Am J Med Sci. 2012; 344: 28-31. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22205116
  15. Wagoner MJ, Laronga C, Acs G. Extent and histologic pattern of atypical ductal hyperplasia present on core needle biopsy specimens of the breast can predict ductal carcinoma in situ in subsequent excision. Am J Clin Pathol. 2009; 131: 112-21. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19095574
  16. Deshaies I, Provencher L, Jacob S, et al. Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy. Breast 2011; 20: 50-55. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20619647
  17. Dominici L, Liao GS, Brock J. Large needle core biopsy of atypical ductal hyperplasia: results of surgical excision. Breast J. 2012; 18: 506-508. https://www.ncbi.nlm.nih.gov/pubmed/22897750
  18. Hong ZJ, Chu CH, Fan, HL, Hsu HM, Chen CJ, et al. Factors predictive of breast cancer in open biopsy in cases with atypical ductal hyperplasia diagnosed by ultrasound-guided core needle biopsy. Eur J Surg Oncol. 2011; 37: 758-764. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21764539
  19. Sneige N, Lim SC, Whitman GJ, Krishnamurthy S, Sahin AA, et al. Atypical ductal hyperplasia diagnosis by directional vacuum-assisted stereotactic biopsy of breast microcalcification. Am J Clin Pathol. 2003; 119: 248-253. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12579995
  20. Forgeard C, Benchaib M, Guerin N, Thiesse P, Mignotte H, et al. Is surgical biopsy mandatory in case of atypical ductal hyperplasia on 11-gauge core needle biopsy? A retrospective study of 300 patients. Am J Surg. 2008; 196: 339-345. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18585676
  21. Mesurolle B, Perez JC, Azzumea F, et al. Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation. AJR 2013; 202: 1389-94. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24848840/
  22. Menes TS, Rosenberg R, Balch S, Jaffer S, Kerlikowske K, et al. Upgrade of high-risk breast lesions detected on mammography in the breast cancer surveillance consortium. Am J Surg. 2014; 207: 24-31. PubMed: https://pubmed.ncbi.nlm.nih.gov/24112677
  23. Chae BJ, Lee A, Song BJ, Jung SS. Predictive factors for breast cancer in patients diagnosed atypical ductal hyperplasia at core needle biopsy. World J Surg Oncol. 2009; 7: 77. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771003/
  24. Catteau X, Simon P, Noël JC. Predictors of invasive breast cancer in mammographically detected microcalcification in patients with a core biopsy diagnosis of flat epithelial atypia, atypical ductal hyperplasia or ductal carcinoma in situ and recommendations for a selective approach to sentinel node biopsy. Pathol Res Pract. 2012; 208: 217-220. PubMed: https://pubmed.ncbi.nlm.nih.gov/22445178/
  25. Gümüş H, Mills P, Gumus M, Fish D, Jones S, et al. Factors that impact the upgrading of atypical ductal hyperplasia. Diagn Interv Radiol. 2013; 19: 91-96. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23019055
  26. Ely KA, Carter BA, Jensen RA, Simpson JF, Page DL. Core biopsy of the breast with atypical ductal hyperplasia. A probabilistic approach to reporting. Am J Surg Pathol. 2001; 25: 1017-1021. PubMed: https://pubmed.ncbi.nlm.nih.gov/11474285/
  27. Kohr JR, Eby PR, Allison KH, DeMartini WB, Gutierrez RL, et al. Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. Radiology 2010; 255: 723-730. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20173103
  28. Bendifallah S, Defert S, Chabbert-Buffet N, Maurin N, Chopier J, et al. Scoring to predict the possibility of upgrades to malignancy in atypical ductal hyperplasia diagnosed by an 11-gauge vacuum-assisted biopsy device: an external validation study. Eur J Cancer. 012; 48: 30-36. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22100905
  29. Caplain, A, Drouet Y, Peyron M, Peix M, Faure C, et al. Management of patients diagnosed with atypical ductal hyperplasia by vacuum-assisted core biopsy: a prospective assessment of the guidelines used at our institution. Am J Surg. 014; 208: 260-267. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24680949
  30. Page DL. Cancer risk assessment in benign breast biopsies. Hum Pathol. 1986; 17: 871-874. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3759071
  31. Rosai J. Borderline epithelial lesions of the breast. Am J Surg Pathol. 1991; 15: 209-221. PubMed: https://pubmed.ncbi.nlm.nih.gov/1847606/
  32. Hartmann LC, Radisky DC, Frost MH, Santen RJ, Vierkant RA, et al. Understanding the premalignant potential of atypical hyperplasia through its natural history: a longitudinal cohort study. Cancer Prev Res. 2014; 7: 211-217. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167687/
  33. Jackman RJ, Nowels KW, Shepard MJ, Finkelstein SI, Marzoni FA, Jr et al. Stereotaxic large core needle biopsy of 450 nonpalpable breast lesions with surgical correction in lesions with cancer or atypical hyperplasia. Radiology. 1994; 193: 91-5. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8090927
  34. Jackman RJ, Birdwell RL, Ikeda DM. Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision? Radiology. 2002; 224: 548-554. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12147855
  35. Allison KH, Eby PR, Kohr J, DeMartini WB, Lehman CD, et al. Atypical ductal hyperplasia on vacuum-assisted breast biopsy: suspicion for ductal carcinoma in situ can stratify patients at high risk of upgrade. Hum Pathol. 2011; 42: 41-50. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20970167
  36. Adrales G, Turk P, Wallace T, Bird R, Norton HJ, et al. Is surgical excision necessary for atypical ductal hyperplasia of the breast diagnosed by Mammotome? Am J Surg. 2000; 180: 313-315. PubMed: https://pubmed.ncbi.nlm.nih.gov/11113443/

Figures:

Figure 1

Figure 1

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More