title: Is the upgrade rate of atypical ductal hyperplasia diagnosed by core needle biopsy of calcifications different for digital and film-screen mammography?
abstract: OBJECTIVE
  The purpose of this study was to establish the upgrade rate of atypical ductal hyperplasia (ADH) diagnosed by stereotactic vacuum-assisted core needle biopsy for calcifications detected by digital mammography as compared with film-screen mammography.
  
  
  METHODS
  A retrospective record search identified 101 cases of ADH. Criteria included women with calcifications biopsied using stereotactic vacuum-assisted core needle biopsy at our institution between January 2001 and December 2011. The center transitioned from film-screen mammography in 2001 to all digital mammography by 2010. Stereotactic vacuum-assisted core needle biopsies were performed using 11-gauge (59/101 [58%]) or 8-gauge (42/101 [42%]) needles. All pathology was interpreted by breast pathologists using standard criteria.
  
  
  RESULTS
  Of 101 cases of ADH, 57 (56.4%) were detected using digital and 44 (43.6%) were detected using film-screen mammography. Seven of 57 (12.3%) cases of ADH detected by digital mammography were upgraded to ductal carcinoma in situ (DCIS) (n = 6) or invasive cancer (n = 1). Six of 44 (13.6%) cases of ADH detected by film-screen mammography were upgraded to DCIS (n = 5) or invasive cancer (n = 1) (p = 0.84). There was a trend toward low-grade DCIS in cases detected by digital mammography (3/7 [42.9%]) as compared with film-screen mammography (1/6 [16.7%]) (p = 0.68). A nonsignificant overall higher percentage of upgrades occurred when calcifications were not completely removed (10/52 [19.2%]) as compared with completely removed (3/47 [6.4%]). There was no difference in upgrade rate of stereotactic vacuum-assisted core needle biopsy performed using 11-gauge (7/59 [11.9%]) versus 8-gauge (6/42 [14.3%]) needles.
  
  
  CONCLUSIONS
  The upgrade rate of ADH diagnosed by stereotactic vacuum-assisted core needle biopsy was not significantly different between digital and film-screen mammography. The current recommendation for excision of ADH diagnosed by stereotactic vacuum-assisted core needle biopsy should be applied to ADH detected by digital mammography.
authors.affiliation: 1 Division of Breast Imaging, Department of Radiology, University of Michigan Health System, C415 Med Inn Bldg, SPC 5842, 1500 E Medical Center Dr, Ann Arbor, MI 48109.
authors.forename: Carol T
authors.initials: CT
authors.lastname: McLaughlin
authors.forename: Colleen H
authors.initials: CH
authors.lastname: Neal
authors.forename: Mark A
authors.initials: MA
authors.lastname: Helvie
mesh_terms: D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000175:diagnosis*; D002114:Calcinosis / Q000175:diagnosis*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014962:X-Ray Film
keywords: atypical ductal hyperplasia; digital mammography; upgrade