Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy.
BACKGROUND
The aim of this study was to determine factors that predict under-evaluation of malignancy in patients diagnosed with atypical ductal hyperplasia (ADH) at ultrasound-guided core needle biopsy (CNB), and to develop a prediction algorithm for scoring the possibility of a diagnosis upgrade to malignancy based on clinical, radiological and pathological factors.


METHODS
The study enrolled patients diagnosed with ADH at ultrasound-guided CNB who subsequently underwent surgical excision of the lesion. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy.


RESULTS
A total of 102 patients with ADH at CNB were identified. Of the 74 patients who underwent subsequent surgical excision, 34 (45.8%) were diagnosed with invasive or in situ malignant foci. Multivariate analysis revealed that age>50 years, microcalcification on mammography, size on imaging>15 mm and a palpable lesion were independent predictors of malignancy. Focal ADH was a negative predictor. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.903 (95% CI: 0.82-0.94), and the negative predictive value was 100% for a score<or=3.5. Similar findings were observed for a validation dataset of 54 patients at other institutions.


CONCLUSIONS
A scoring system to predict malignancy in patients diagnosed with ADH at CNB was developed based on five factors: age, palpable lesion, microcalcification on mammography, size on imaging and focal ADH. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Eunyoung
E
Ko
Wonshik
W
Han
Jong Won
JW
Lee
Jihyoung
J
Cho
Eun-Kyu
EK
Kim
So-Youn
SY
Jung
Mee Joo
MJ
Kang
Woo Kyung
WK
Moon
In Ae
IA
Park
Sung-Won
SW
Kim
Ku Sang
KS
Kim
Eun Sook
ES
Lee
Kyu Hong
KH
Min
Seok Won
SW
Kim
Dong-Young
DY
Noh
D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve; D016217:Ultrasonography, Mammary