title: Discrepancies in the diagnosis of intraductal proliferative lesions of the breast and its management implications: results of a multinational survey.
abstract: To measure discrepancies in diagnoses and recommendations impacting management of proliferative lesions of the breast, a questionnaire of five problem scenarios was distributed among over 300 practicing pathologists. Of the 230 respondents, 56.5% considered a partial cribriform proliferation within a duct adjacent to unequivocal ductal carcinoma in situ (DCIS) as atypical ductal hyperplasia (ADH), 37.7% of whom recommended reexcision if it were at a resection margin. Of the 43.5% who diagnosed the partially involved duct as DCIS, 28.0% would not recommend reexcision if the lesion were at a margin. When only five ducts had a partial cribriform proliferation, 35.7% considered it as DCIS, while if >or=20 ducts were so involved, this figure rose to 60.4%. When one duct with a complete cribriform pattern measured 0.5, 1.5, or 4 mm, a diagnosis of DCIS was made by 22.6, 31.3, and 94.8%, respectively. When multiple ducts with flat epithelial atypia were at a margin, 20.9% recommended reexcision. Much of these discrepancies arise from the artificial separation of ADH and low-grade DCIS and emphasize the need for combining these two under the umbrella designation of ductal intraepithelial neoplasia grade 1 (DIN 1) to diminish the impact of different terminologies applied to biologically similar lesions.
authors.affiliation: Department of Pathology, Yale University School of Medicine, Lauder Hall (LH) 222, 310 Cedar St., New Haven, CT 06510, USA.
authors.forename: Mohiedean
authors.initials: M
authors.lastname: Ghofrani
authors.forename: Beatriz
authors.initials: B
authors.lastname: Tapia
authors.forename: Fattaneh A
authors.initials: FA
authors.lastname: Tavassoli
mesh_terms: D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D002278:Carcinoma in Situ / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D015588:Observer Variation