Atypical ductal hyperplasia bordering on DCIS on core biopsy is associated with higher risk of upgrade than conventional atypical ductal hyperplasia Journal Article

   

Authors:	Pawloski, K. R.; Christian, N.; Knezevic, A.; Wen, H. Y.; Van Zee, K. J.; Morrow, M.; Tadros, A. B.
Article Title:	Atypical ductal hyperplasia bordering on DCIS on core biopsy is associated with higher risk of upgrade than conventional atypical ductal hyperplasia
Abstract:	Purpose: Upgrade rates of conventional ADH are reported at 10–30%; however, rates for ADH bordering on DCIS (ADH-BD) are largely unknown. We examined the upgrade rate of ADH-BD and core needle biopsy (CNB) features associated with upgrade. Surgical management in patients with concurrent ipsilateral breast cancer (BC) was also examined. Methods: From 2000 to 2018, women with CNB diagnosis of ADH-BD were prospectively identified. Women with pure ADH-BD and concurrent ipsilateral ADH-BD/BC were analyzed separately, and upgrade rates were calculated. CNB features associated with upgrade and type of surgery were examined in women with pure ADH-BD; CNB features and concurrent pathology associated with upgrade were examined in women with ipsilateral BC. Results: 108/236 (46%) patients with pure ADH-BD on CNB had DCIS (40%) or invasive carcinoma (6%) on surgical excision. DCIS or invasive carcinoma was more frequently found on excision of a mass that yielded ADH-BD on biopsy than excision of calcifications (65% vs 38%; p < 0.001). The breast conservation success rate was high (80%) in patients who upgraded, despite a high re-excision rate of 46%. The upgrade rate of ADH-BD in women with concurrent ipsilateral BC was 41%. Most women (94%) with ADH-BD in the same quadrant as the BC were candidates for breast conserving surgery, with a success rate of 89%. Conclusion: The upgrade rate for pure ADH-BD is significantly higher than that reported for women with conventional ADH, especially in women with a mass on imaging. The upgrade rate of concurrent ipsilateral ADH-BD and BC is similarly high. Excision with a margin of normal tissue and specimen inking should be routine to minimize the need for re-excision. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords:	breast surgery; ductal carcinoma in situ; atypical ductal hyperplasia; borderline lesions; ipsilateral breast cancer; markedly atypical ductal hyperplasia
Journal Title:	Breast Cancer Research and Treatment
Volume:	184
Issue:	3
ISSN:	0167-6806
Publisher:	Springer
Date Published:	2020-12-01
Start Page:	873
End Page:	880
Language:	English
DOI:	10.1007/s10549-020-05890-1
PUBMED:	32857242
PROVIDER:	scopus
PMCID:	PMC7657999
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85089915132&doi=10.1007%2fs10549-020-05890-1&partnerID=40&md5=475fb40c1e8f282a504204b0bd0fa182
Notes:	Article -- Export Date: 1 December 2020 -- Source: Scopus

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