title: Early Breast Cancer Precursor Lesions: Lessons Learned from Molecular and Clinical Studies.
abstract: Atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), and lobular neoplasia (LN) form a group of early precursor lesions that are part of the low-grade pathway in breast cancer development. This concept implies that the neoplastic disease process begins at a stage much earlier than in situ carcinoma. We have performed a review of the published literature for the upgrade risk to ductal carcinoma in situ or invasive carcinoma in open biopsy after a diagnosis of ADH, FEA, or LN in core needle biopsy. This has revealed the highest upgrade risk for ADH (28.2% after open biopsy), followed by LN (14.9%), and FEA (10.2%). With LN, the pleomorphic subtype is believed to confer a higher risk than classical LN. With all types of precursor lesions, careful attention must be paid to the clinicopathological correlation for the guidance of the clinical management. Follow-up biopsies are generally indicated in ADH, and if there is any radiological-pathological discrepancy, also in LN or FEA.
authors.affiliation: Department of Pathology, University of Heidelberg, Germany.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Sinn
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Elsawaf
authors.forename: Birgit
authors.initials: B
authors.lastname: Helmchen
authors.forename: Sebastian
authors.initials: S
authors.lastname: Aulmann