Is surgical excision of focal atypical ductal hyperplasia warranted? Experience at a tertiary care center Journal Article
| Authors: | Grabenstetter, A.; Brennan, S. B.; Sevilimedu, V.; Kuba, M. G.; Giri, D. D.; Wen, H. Y.; Morrow, M.; Brogi, E. |
| Article Title: | Is surgical excision of focal atypical ductal hyperplasia warranted? Experience at a tertiary care center |
| Abstract: | Background: The core-needle biopsy (CNB) diagnosis of atypical ductal hyperplasia (ADH) generally mandates follow-up excision, but controversy exists on whether small foci of ADH require surgical management. This study evaluated the upgrade rate at excision of focal ADH (fADH), defined as 1 focus spanning ≤ 2 mm. Methods: We retrospectively identified in-house CNBs with ADH as the highest-risk lesion obtained between January 2013 and December 2017. A radiologist assessed radiologic–pathologic concordance. All CNB slides were reviewed by two breast pathologists, and ADH was classified as fADH and nonfocal ADH based on extent. Only cases with follow-up excision were included. The slides of excision specimens with upgrade were reviewed. Results: The final study cohort consisted of 208 radiologic-pathologic concordant CNBs, including 98 fADH and 110 nonfocal ADH. The imaging targets were calcifications (n = 157), a mass (n = 15), nonmass enhancement (n = 27), and mass enhancement (n = 9). Excision of fADH yielded seven (7%) upgrades (5 ductal carcinoma in situ (DCIS), 2 invasive carcinoma) versus 24 (22%) upgrades (16 DCIS, 8 invasive carcinoma) at excision of nonfocal ADH (p = 0.01). Both invasive carcinomas found at excision of fADH were subcentimeter tubular carcinomas away from the biopsy site and deemed incidental. Conclusions: Our data show a significantly lower upgrade rate at excision of focal ADH than nonfocal ADH. This information can be valuable if nonsurgical management of patients with radiologic-pathologic concordant CNB diagnosis of focal ADH is being considered. © 2023, Society of Surgical Oncology. |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 30 |
| Issue: | 7 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2023-01-01 |
| Start Page: | 4087 |
| End Page: | 4094 |
| Language: | English |
| DOI: | 10.1245/s10434-023-13319-4 |
| PUBMED: | 36905438 |
| PROVIDER: | scopus |
| PMCID: | PMC10542905 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in PubMed and PDF -- Corresponding author is MSK author: Anne Grabenstetter -- Source: Scopus |
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