title: Factors that impact the upgrading of atypical ductal hyperplasia.
abstract: OBJECTIVE
  The purpose of this study was to identify the factors that may have an impact on upgrading atypical ductal hyperplasia (ADH) lesions to malignancy.
  
  
  METHODS
  Between February 1999 and December 2010, the records of 150 ADH lesions that had been biopsied were retrospectively reviewed. The biopsy types included 11-gauge stereotactic vacuum-assisted biopsy (SVAB) (n=102) and ultrasonography (US)-guided 14-gauge automated biopsy (n=48). The patients were divided into two groups: those who had cancer in the final pathology and those who did not. Variables associated with underestimation of ADH lesions were compared between the groups.
  
  
  RESULTS
  The underestimation rates according to the biopsy types were 41.7% (20/48) for the US-guided 14-gauge automated biopsy and 20.6% (21/102) for the 11-gauge SVAB (P = 0.007). The rate of underestimation was significantly higher in lesions greater than 7 mm than it was in smaller lesions, with both US-guided 14-gauge automated biopsy and 11-gauge SVAB (P = 0.024 and P = 0.042, respectively). The rate of underestimation was significantly higher with the 11-gauge SVAB (P = 0.025) in lesions that were suspicious (R4) and highly suggestive of malignancy (R5) than in those that were probably benign (R3).
  
  
  CONCLUSIONS
  The underestimation rate in ADH lesions was significantly higher with US-guided 14-gauge automated biopsy compared to the 11-gauge SVAB. The underestimation rate was also significantly higher in lesions greater than 7 mm regardless of the biopsy type, and in lesions biopsied using SVAB that were regarded as suspicious (R4) or highly suggestive of malignancy (R5) on imaging.
authors.affiliation: Department of Radiology, Dicle University School of Medicine, Diyarbakir, Turkey. drhaticegumus@hotmail.com
authors.forename: Hatice
authors.initials: H
authors.lastname: Gümüş
authors.forename: Philippa
authors.initials: P
authors.lastname: Mills
authors.forename: Metehan
authors.initials: M
authors.lastname: Gümüş
authors.forename: David
authors.initials: D
authors.lastname: Fish
authors.forename: Sue
authors.initials: S
authors.lastname: Jones
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.forename: Haresh
authors.initials: H
authors.lastname: Devalia
authors.forename: Ali
authors.initials: A
authors.lastname: Sever
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis / Q000473:pathology; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D016683:Supine Position; D018084:Ultrasonography, Interventional / Q000379:methods; D014618:Vacuum