Atypical ductal hyperplasia in directional vacuum-assisted biopsy of breast microcalcifications: considerations for surgical excision.
BACKGROUND
Our goal was to analyze clinicopathologic features of patients with atypical ductal hyperplasia (ADH) diagnosed on directional vacuum-assisted biopsy (DVAB) targeting microcalcifications to identify factors predicting the presence of carcinoma.


METHODS
We retrospectively evaluated the clinical, mammographic, and histologic features of 140 patients with DVAB-diagnosed ADH who underwent either segmental excision (86.4%) or mammographic follow-up (≥2 years; 13.6%). Cases with mass lesions or ipsilateral cancer were excluded.


RESULTS
In 16 cases, carcinoma was found on excision. All cases without excision showed no new abnormalities on mammographic follow-up. Only the amount of calcifications removed (≤95%) significantly correlated with the rate of upgrade of ADH to carcinoma (P = .037). Significant histologic predictors of upgrade to carcinoma included number of terminal duct-lobular units (TDLU; >2) involved (P = .0306), presence of significant cytologic atypia suspicious for intermediate or high-grade carcinoma (P < .0001), and necrosis (P = .0006). Among ADH cases without significant atypia and/or necrosis, the extent of ADH (≤2 vs. >2 TDLU involved) was not a significant predictor of carcinoma (P = 1.0000).


CONCLUSIONS
ADH associated with calcifications in the absence of a mass lesion can be categorized into different risk groups using a multidisciplinary approach with correlation of histologic and mammographic findings. ADH lesions with significant cytologic atypia and/or necrosis are most likely to be associated with carcinoma and should be excised. ADH without these features, regardless of extent of involvement, and with >95% removal of the targeted calcifications, is associated with a minimal risk (<3%) of carcinoma and may undergo mammographic follow-up only.
Nguyen
Christopher V
CV
Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Albarracin
Constance T
CT
Whitman
Gary J
GJ
Lopez
Adriana
A
Sneige
Nour
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D002114:Calcinosis / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000150:complications / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014618:Vacuum