The risk of upgrade for atypical ductal hyperplasia detected on magnetic resonance imaging-guided biopsy: a study of 100 cases from four academic institutions.
OBJECTIVE
To identify variables that can predict upgrade for magnetic resonance imaging (MRI)-detected atypical ductal hyperplasia (ADH).


RESULTS
We reviewed 1655 MRI-guided core biopsies between 2005 and 2013, yielding 100 (6%) cases with ADH. The pathological features of ADH and MRI findings were recorded. An upgrade was considered when the subsequent surgical excision yielded invasive carcinoma (IC) or ductal carcinoma in situ (DCIS). The rate of ADH between institutions was 3.3-7.1%, with an average of 6%. A total of 15 (15%) cases had upgrade, 12 DCIS and three IC. When all cases were included, only increased number of involved cores was statistically significant (P = 0.02). When cases with concurrent lobular neoplasia (LN) were excluded (n = 14), increased number of ADH foci and increased number of involved cores were statistically significant (P = 0.002, P = 0.009). We analysed the data separately from a single institution (n = 61). Increased number of foci, increased number of total cores and involved cores and larger ADH size predicted upgrade with statistical significance.


CONCLUSIONS
The incidence of ADH in MRI-guided core biopsy is rare. The rate of upgrade is comparable to mammographically detected ADH, warranting surgical excision. Similar to mammographically detected lesions, the volume of the ADH predicts the upgrade.
Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA.
Thaer
T
Khoury
Department of Pathology, Ohio State University, Columbus, OH, USA.
Zaibo
Z
Li
Department of Pathology, Washington University, St Louis, MO, USA.
Souzan
S
Sanati
Department of Pathology, Vanderbilt University, Nashville, TN, USA.
Mohamed M
http://orcid.org/0000-0002-1830-6222
MM
Desouki
Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA.
Xiwei
X
Chen
Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA.
Dan
D
Wang
Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA.
Song
S
Liu
Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Rouzan
R
Karabakhtsian
Department of Radiology, Roswell Park Cancer Institute, Buffalo, NY, USA.
Prasanna
P
Kumar
Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Beatriu
B
Reig
D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D060787:Neoplasm Grading; D012306:Risk
atypical ductal hyperplasia; breast; magnetic resonance imaging; upgrade