title: Atypical hyperplasia of the breast: the black hole of routine breast cancer screening.
abstract: OBJECTIVE
  Determination of the prevalence, of the radiological and clinical characteristics, and outcome of atypical hyperplasia (AH) of the breast within a population subjected to routine screening (double-view mammography with double reading, performed every two years between 50 and 75 years of age).
  
  
  METHODS
  The clinical and radiological records and histological findings of percutaneous and surgical biopsy specimens of sixty-eight patients presenting with AH were reviewed together with patient follow-up data after percutaneous and surgical biopsy.
  
  
  RESULTS
  AH incidence in the population was 0.19‰ with the following distribution of lesions: atypical epithelial hyperplasia (AEH, 53%), columnar cell metaplasia with atypia (CCMA, 32%), and lobular intraepithelial neoplasia (LIN, 8%). The mean patient age was 58 years and 24% of patients were receiving hormone replacement therapy. The main radiological finding was the presence of microcalcifications for AEH and CCMA lesions in particular, and the mammograms were valid (correlation between American College of Radiology score and risk of lesion, only 3% of lesions were recognized on the second reading). A total of 13.7% of AH cases were underestimated and a real risk of AH progression was observed, regardless of whether or not surgical biopsy had been performed.
  
  
  CONCLUSIONS
  The clinical and radiological characteristics of AH observed in a population subjected to routine breast cancer screening are identical to those for patients with the same lesions referred to specialist centers. Surgical biopsy remains the recommended option due to the risk of underestimation of lesions by percutaneous biopsy and the risk of progression justifies the need for continued close monitoring.
authors.affiliation: Service de Gynécologie CHU Anne de Bretagne 16 Bd de Bulgarie BP 90 347 F-35 203 Rennes Cedex 2, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Picouleau
authors.forename: Martine
authors.initials: M
authors.lastname: Denis
authors.forename: Vincent
authors.initials: V
authors.lastname: Lavoue
authors.forename: Patrick
authors.initials: P
authors.lastname: Tas
authors.forename: Habiba
authors.initials: H
authors.lastname: Mesbah
authors.forename: Philippe
authors.initials: P
authors.lastname: Poree
authors.forename: Jean
authors.initials: J
authors.lastname: Leveque
authors.forename: Karine
authors.initials: K
authors.lastname: Morcel
mesh_terms: D000368:Aged; D001706:Biopsy; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D008327:Mammography / Q000379:methods; D008875:Middle Aged