title: Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy.
abstract: Previous studies have shown that 4-54% of breast lesions reported on core biopsies as atypical ductal hyperplasia (ADH) are upgraded on further excision to ductal carcinoma in situ (DCIS) or invasive carcinoma. We evaluated the rate of upgrading ADH to carcinoma at surgery for ADH diagnosed by percutaneous biopsy, and examined characteristics associated with malignancy. We identified 13,488 consecutive biopsies conducted at one center over a nine-year period. A total of 422 biopsies with ADH in 415 patients were included. DCIS or invasive carcinoma was found in 132 cases (31.3% upgrading). Multivariate model revealed that ipsilateral breast symptoms, mammographic lesion other than microcalcifications alone, 14G core needle biopsy, papilloma co-diagnosis, severe ADH and pathologists with lower volume of ADH diagnosis were factors statistically associated with malignancy. However, no subgroups were identified for safe clinical-only follow-up. Surgery is recommended in all cases of ADH diagnosed by percutaneous breast biopsy.
authors.affiliation: Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada. isabelle.deshaies@gmail.com
authors.forename: Isabelle
authors.initials: I
authors.lastname: Deshaies
authors.forename: Louise
authors.initials: L
authors.lastname: Provencher
authors.forename: Simon
authors.initials: S
authors.lastname: Jacob
authors.forename: Gary
authors.initials: G
authors.lastname: Côté
authors.forename: Jean
authors.initials: J
authors.lastname: Robert
authors.forename: Christine
authors.initials: C
authors.lastname: Desbiens
authors.forename: Brigitte
authors.initials: B
authors.lastname: Poirier
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Hogue
authors.forename: Eric
authors.initials: E
authors.lastname: Vachon
authors.forename: Caroline
authors.initials: C
authors.lastname: Diorio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D016017:Odds Ratio; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors