title: Management of patients diagnosed with atypical ductal hyperplasia by vacuum-assisted core biopsy: a prospective assessment of the guidelines used at our institution.
abstract: BACKGROUND
  Because of underestimation, surgical excision is recommended for atypical ductal hyperplasia diagnosed on directional vacuum-assisted biopsies. The following guidelines have been established according to our retrospective study published in 2008: excision for lesions ≥ 21 mm, follow-up for lesions <6 mm with complete removal of microcalcifications, and follow-up or excision for 6 to 21-mm lesions with respectively less or >2 atypical ductal hyperplasia foci.
  
  
  RESULTS
  These guidelines were assessed in a prospective series of 124 patients with a median follow-up of 30 months. Conformity rate was 92%. Upgrading was 28% (15 of 53 patients) for conformed surgery and absent for surgery performed beyond the scope of guidelines. For the patients with benign result at surgery (n = 38) or just followed (n = 61), 3 cancers occurred in either breast at 1 to 3 years.
  
  
  CONCLUSIONS
  These convenient guidelines can safely spare surgery for a subset of patients. However, annual mammographic follow-up is recommended since the risk of subsequent cancer remains high for both breasts.
authors.affiliation: Department of Oncologic Surgery, Centre Léon Bérard, Lyon, France.
authors.forename: Alizée
authors.initials: A
authors.lastname: Caplain
authors.affiliation: Department of Public Health, Centre Léon Bérard, Lyon, France; Université Lyon 1, CNRS UMR 5558, Centre Léon Bérard, Lyon, France.
authors.forename: Youenn
authors.initials: Y
authors.lastname: Drouet
authors.affiliation: Department of Pathology, Centre Léon Bérard, Lyon, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Peyron
authors.affiliation: Department of Radiology, Centre Léon Bérard, Lyon, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Peix
authors.affiliation: Department of Oncologic Surgery, Centre Léon Bérard, Lyon, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Faure
authors.affiliation: Department of Pathology, Centre Léon Bérard, Lyon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chassagne-Clément
authors.affiliation: Department of Oncologic Surgery, Centre Léon Bérard, Lyon, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Beurrier
authors.affiliation: Department of Pathology, Centre Léon Bérard, Lyon, France.
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Fondrevelle
authors.affiliation: Department of Radiology, Centre Léon Bérard, Lyon, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Guérin
authors.affiliation: Department of Public Health, Centre Léon Bérard, Lyon, France; Université Lyon 1, CNRS UMR 5558, Centre Léon Bérard, Lyon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Lasset
authors.affiliation: Department of Pathology, Centre Léon Bérard, Lyon, France. Electronic address: isabelle.treilleux@lyon.unicancer.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Treilleux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology*; D002114:Calcinosis / Q000473:pathology*; D002278:Carcinoma in Situ / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D042361:Mammary Glands, Human / Q000473:pathology*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000473:pathology*; D018084:Ultrasonography, Interventional; D016217:Ultrasonography, Mammary; D014618:Vacuum
keywords: Atypical ductal hyperplasia; Directional vacuum-assisted biopsy; Mammographic follow-up; Prospective study; Surgical excision; Upstaging–underestimation