Validation of a scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia using an ultrasound-guided core needle biopsy.
OBJECTIVE
The need for surgical excision in patients with ultrasound-guided core needle biopsy (CNB)-diagnosed atypical ductal hyperplasia (ADH) remains an issue of debate. The present study sought to validate a scoring system (the U score, for underestimation) that we have previously developed for predicting malignancy in CNB-diagnosed ADH.


METHODS
The study prospectively enrolled 85 female patients with CNB-diagnosed ADH who underwent subsequent surgical excision. Underestimation was defined as a surgical specimen having malignant foci.


RESULTS
The overall underestimation rate was 37% (31/85). Multivariate analysis showed that a clinically palpable mass, microcalcification on imaging, size >15 mm and a patient age of ≥50 years were independently associated with underestimation. When applied to the scoring system, the validation score was significant (p<0.001; area under the curve, 0.852). No patient with a U score <3.5 had an underestimated lesion.


CONCLUSIONS
The present study successfully validated the efficacy of our scoring system for predicting malignancy in CNB-diagnosed ADH. A U score of ≤3.5 indicates that surgical excision may not be necessary.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Jisun
J
Kim
Wonshik
W
Han
Eun-Young
EY
Go
Hyeong-Gon
HG
Moon
Soo Kyung
SK
Ahn
Hee-Chul
HC
Shin
Jee-Man
JM
You
Jung Min
JM
Chang
Nariya
N
Cho
Woo Kyung
WK
Moon
In Ae
IA
Park
Dong-Young
DY
Noh
Breast hyperplasia; Breast neoplasms; Diagnostic errors; Needle biopsy