title: Is surgical biopsy mandatory in case of atypical ductal hyperplasia on 11-gauge core needle biopsy? A retrospective study of 300 patients.
abstract: BACKGROUND
  Atypical ductal hyperplasia (ADH) is diagnosed in 4% to 10% of directional vacuum-assisted stereotactic biopsies (DVABs) performed for microcalcifications. Since the underestimation rate varies from 7% to 36%, surgical excision is still recommended, although some authors have tried to identify a subset of patients who can be spared surgery.
  
  
  RESULTS
  In this study, we analyzed a retrospective series of 300 patients with ADH on 11-gauge DVAB. The only 4 events that occurred (3%) in 135 of 184 patients (61%) who were followed may not be due to underestimation. Comparing the diagnoses on DVAB and surgical excisions for 116 patients (39%), we identified 3 subsets of patients: no underestimation (size <6 mm and complete removal), low rate of 4% (< or =2 foci ADH in microcalcifications either <6 mm with incomplete removal or > or =6 mm and <21 mm), and high rate of 36% to 38% (>2 foci ADH in microcalcifications either <6 mm with incomplete removal or > or =6 mm and <21 mm, lesion size > or =21 mm).
  
  
  CONCLUSIONS
  Our results suggest that strict follow-up can be a safe option for the first 2 groups of patients, but that surgical excision is mandatory for patients from the third group.
authors.affiliation: Department of Pathology, Leon Berard Centre, 28 rue Laennec, 69373 Lyon Cedex 08, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Forgeard
authors.forename: Medhi
authors.initials: M
authors.lastname: Benchaib
authors.forename: Nicole
authors.initials: N
authors.lastname: Guerin
authors.forename: Philippe
authors.initials: P
authors.lastname: Thiesse
authors.forename: Hervé
authors.initials: H
authors.lastname: Mignotte
authors.forename: Christelle
authors.initials: C
authors.lastname: Faure
authors.forename: Catherine
authors.initials: C
authors.lastname: Clement-Chassagne
authors.forename: Isabelle
authors.initials: I
authors.lastname: Treilleux
mesh_terms: D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008327:Mammography; D008875:Middle Aged; D012189:Retrospective Studies; D013238:Stereotaxic Techniques