Can Excision be Avoided for Atypical Ductal Hyperplasia of the Breast Diagnosed on Core Biopsy? Should all cases of ADH be excised?
Abstract
Introduction: Atypical ductal hyperplasia (ADH) diagnosed on core biopsy (CB) is associated with a risk of upgrade to ductal carcinoma in situ (DCIS) or invasive carcinoma on subsequent surgical excision (SE). Although single institutional studies have shown that observation and surveillance can be considered in a select subgroup, most patients undergo surgery. We aim to identify the features least associated with upgrade on SE, who may potentially be spared surgery. Methods: We conducted a retrospective review of imaging, clinical, and pathologic data of ADH diagnosed on CB. The histopathologic characteristics of ADH on CB and SE were recorded and analyzed. Results: Seventy-one CB from 70 patients were included. CB removed >50% of the imaging target in 69% of cases and ≤50% in 31% of cases and showed complete involvement of ductules by ADH in 31% and incomplete involvement in 69%of cases. ADH was focal (≤1 focus) in 58% and non-focal (>1 focus) in 42% of cases. On SE, 5 cases were upgraded to DCIS. The upgrade was more common when CB removed ≤50% of the imaging target compared to >50% (18% vs. 2%). Complete ADH had a significantly higher upgrade rate than incomplete ADH, with no difference between focal and non-focal. Lastly, 48% had low-risk ADH features (incomplete ADH with >50% removal of target). Conclusion: Upgrade is limited to DCIS and is related to sampling adequacy and extent of ADH. Careful histologic-radiologic correlation can identify a subgroup of ADH with low-risk features, representing possible candidates for observation and surveillance.
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