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Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy |
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| Authors: | Isabelle Deshaies,Louise Provencher,Simon Jacob,Gary Cô té ,Jean Robert,Christine Desbiens,Brigitte Poirier,Jean-Charles Hogue |
| Affiliation: | a Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8 b Santé des populations: URESP, Centre de recherche FRSQ du Centre hospitalier affilié universitaire de Québeca, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8 c Département de médecine sociale et préventive, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6 d Département de chirurgie, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6 e Département de biologie moléculaire, biochimie médical et pathologie, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6 f Département de radiologie, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6 |
| Abstract: | Previous studies have shown that 4-54% of breast lesions reported on core biopsies as atypical ductal hyperplasia (ADH) are upgraded on further excision to ductal carcinoma in situ (DCIS) or invasive carcinoma. We evaluated the rate of upgrading ADH to carcinoma at surgery for ADH diagnosed by percutaneous biopsy, and examined characteristics associated with malignancy. We identified 13,488 consecutive biopsies conducted at one center over a nine-year period. A total of 422 biopsies with ADH in 415 patients were included. DCIS or invasive carcinoma was found in 132 cases (31.3% upgrading). Multivariate model revealed that ipsilateral breast symptoms, mammographic lesion other than microcalcifications alone, 14G core needle biopsy, papilloma co-diagnosis, severe ADH and pathologists with lower volume of ADH diagnosis were factors statistically associated with malignancy. However, no subgroups were identified for safe clinical-only follow-up. Surgery is recommended in all cases of ADH diagnosed by percutaneous breast biopsy. |
| Keywords: | Atypical ductal hyperplasia Carcinoma Core needle biopsy Vacuum-assisted biopsy Upgrading rate Underestimation |
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