Atypical Ductal Hyperplasia on Percutaneous Breast Biopsy: Scoring System to Identify the Lowest Risk for Upgrade Low-Risk ADH features

Amanda Amin (1), Onalisa Winblad (2), Allison Zupon (3), Fang Fan (4), Ossama Tawfik (5), Jo Wick (6), Suzanne Hunt (7), Jason Gatewood (8), Marc Inciardi (9), Jamie Wagner (10)
(1) The University of Kansas Health System, Department of Surgery, Kansas City, USA, United States,
(2) The University of Kansas Health System, Department of Radiology, Kansas City, USA , United States,
(3) The University of Kansas Health System, Department of Radiology, Kansas City, USA , United States,
(4) The University of Kansas Health System, Department of Pathology, Kansas City, USA , United States,
(5) The University of Kansas Health System, Department of Pathology, Kansas City, USA , United States,
(6) The University of Kansas Health System, Department of Biostatistics, Kansas City, USA, United States,
(7) The University of Kansas Health System, Department of Biostatistics, Kansas City, USA, United States,
(8) The University of Kansas Health System, Department of Radiology, Kansas City, USA , United States,
(9) Department of radiology, University of Kansas Health System, Kansas, USA, United States,
(10) The University of Kansas Health System, Department of Surgery, Kansas City, USA, United States

Abstract

Background: NCCN guidelines recommend surgical excision for patients with atypical ductal hyperplasia (ADH) on percutaneous biopsy. Improved imaging and biopsy techniques have lower contemporary upgrade rates, challenging standard practice. We sought to identify low-risk features of ADH to define patients who may benefit from active monitoring over surgical excision.
Methods: A retrospective analysis identified 87 stereotactic biopsies diagnosing ADH undergoing surgical excision at a single institution from 01/2008 to 10/2015. Imaging was reviewed for lesion size and residual calcifications. Biopsy slides were reviewed for ADH features. Categorical variables were analyzed using Chi-square and Fisher’s exact tests; continuous variables with T- and Wilcoxon tests. Logistic regression model was used to determine the association between the number of low-risk features present and odds of upgrade.
Results: Upgrade was identified in 13 cases (14.9%; 11 ductal carcinoma in situ and 2 invasive breast cancer). Low-risk imaging features included imaging size <1cm (P=0.004) and >50% removed by biopsy (P=0.03). The only significant low-risk pathologic feature was the lack of micropapillary features (P=0.10). Focal ADH (1-2 foci, P=0.12) was felt to be clinically significant. Those with the lowest risk of upgrade (0%) had all 4 low-risk features (n=17, 20%). When comparing biopsies that differed by one low-risk feature, the biopsy with one less low-risk feature present had 129% increase in odds of upgrade (exact OR=2.29, 95% CI 1.35, 4.15, P=0.001).
Conclusion: Overall upgrade rate was low in this contemporary cohort. Patients at lowest risk for upgrade had all 4 low-risk features and could be safely offered active monitoring over surgical excision.

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Authors

Amanda Amin
Amanda.Amin@UHhospitals.org (Primary Contact)
Onalisa Winblad
Allison Zupon
Fang Fan
Ossama Tawfik
Jo Wick
Suzanne Hunt
Jason Gatewood
Marc Inciardi
Jamie Wagner
Author Biographies

Jo Wick, The University of Kansas Health System, Department of Biostatistics, Kansas City, USA

Associated Professor, Department of Biostatistics

Jason Gatewood, The University of Kansas Health System, Department of Radiology, Kansas City, USA

Assistant professor in Department of Radiology

Marc Inciardi, Department of radiology, University of Kansas Health System, Kansas, USA

associate professor, 

Jamie Wagner, The University of Kansas Health System, Department of Surgery, Kansas City, USA

associate professor, department of surgery

1.
Amin A, Winblad O, Zupon A, Fan F, Tawfik O, Wick J, Hunt S, Gatewood J, Inciardi M, Wagner J. Atypical Ductal Hyperplasia on Percutaneous Breast Biopsy: Scoring System to Identify the Lowest Risk for Upgrade: Low-Risk ADH features. Arch Breast Cancer [Internet]. 2022 Mar. 4 [cited 2024 Apr. 22];9(2):144-51. Available from: https://archbreastcancer.com/index.php/abc/article/view/512

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