title: Underestimation of cancer in case of diagnosis of atypical ductal hyperplasia (ADH) by vacuum assisted core needle biopsy.
abstract: BACKGROUND
  With the introduction of mammography screening, we are more often dealing with the diagnosis of precancerous and preinvasive breast lesions. An increasing number of patients are observed to show a premalignant change of ADH (atypical ductal hyperplasia). It also involves a wider use of the vacuum assisted core biopsy as a tool for verifying nonpalpable changes identified by mammography.
  
  
  OBJECTIVE
  This paper describes our experience of 134 cases of ADH diagnosed at Mammotome(®) vacuum core needle biopsy.
  
  
  METHODS
  Of 4326 mammotomic biopsies performed at our institution in 2000-2006, ADH was diagnosed in 134 patients (3.1%). Patients underwent surgery to remove the suspected lesion. All histopathological blocks were again reviewed by one pathologist. Clinical, radiological and pathological data were collected for statistical evaluation.
  
  
  RESULTS
  Underestimation of invasive changes occurred in 12 patients (9%). The only clinicopathologic feature of statistical significance radiologically and pathologically was the presence of radial scar in the mammography.
  
  
  CONCLUSIONS
  More frequent diagnosis of precancerous changes in the mammotomic breast biopsy forces us to establish a clear clinical practice. The problem is the underestimation of invasive changes. The occurrence of radial scar on mammography for diagnosis of the presence of ADH increases the risk of invasive changes.
authors.affiliation: 1st Surgical Oncology and General Surgery Department, Greater Poland Cancer Centre, Poznan, Poland.
authors.forename: Karol
authors.initials: K
authors.lastname: Polom
authors.affiliation: 1st Surgical Oncology and General Surgery Department, Greater Poland Cancer Centre, Poznan, Poland.
authors.forename: Dawid
authors.initials: D
authors.lastname: Murawa
authors.affiliation: Department of Pathological Oncology, Greater Poland Cancer Centre, Poznan, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Kurzawa
authors.affiliation: Biostatistics Department University of Medical Sciences, Poznan, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Michalak
authors.affiliation: 1st Surgical Oncology and General Surgery Department, Greater Poland Cancer Centre, Poznan, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Murawa
keywords: Atypical ductal hyperplasia; Breast cancer; Core biopsy