title: Long-Term Safety of Observation in Selected Women Following Core Biopsy Diagnosis of Atypical Ductal Hyperplasia.
abstract: OBJECTIVE
  Atypical ductal hyperplasia (ADH) found on core biopsy is associated with an upgrade to carcinoma in 10-30 % of women, thus surgical excision remains the standard of care. This study compares the incidence of breast cancer in women with ADH who were observed with those who underwent surgical excision of the ADH site.
  
  
  METHODS
  Our departmental, prospectively maintained registry was reviewed to identify patients with ADH diagnosed by core biopsy. Surgically treated patients were excluded if upstaged to carcinoma following excision for ADH diagnosis. Breast cancer events were classified as index site (site of ADH biopsy), ipsilateral breast unrelated to index site, or contralateral breast.
  
  
  RESULTS
  Overall, 175 women met the study criteria; 125 were observed and 50 underwent excision. With a median follow-up of 3 years, 14 breast cancer events were noted in 13 patients. In the surgery group, six women developed breast cancer (12 %), including one bilateral, compared with seven cancers (5.6 %) in the observed group (p = 0.14). Index site events and ipsilateral cancers were the same in both groups [2 vs. 0.8 % (p = 0.49) and 4 versus 4.8 % (p = 1.00), respectively]. All contralateral cancers occurred in the surgical group (8 vs. 0 %; p < 0.01). A prior history of breast cancer was the only variable associated with subsequent breast cancer events (hazard ratio 12.53, 95 % confidence interval 3.30-47.57).
  
  
  CONCLUSIONS
  Observation is appropriate in selected women with ADH on core biopsy. Index site failures are rare and are superseded by cancer risk elsewhere in the breast.
authors: Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Rhiana S
authors: RS
authors: Menen
authors: Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Nivetha
authors: N
authors: Ganesan
authors: Department of Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Therese
authors: T
authors: Bevers
authors: Department of Biostatics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Jun
authors: J
authors: Ying
authors: Department of Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Robin
authors: R
authors: Coyne
authors: Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Deanna
authors: D
authors: Lane
authors: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Constance
authors: C
authors: Albarracin
authors: Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ibedrosian@mdanderson.org.
authors: Isabelle
authors: I
authors: Bedrosian
mesh_terms: D000368:Aged; D062005:Biopsy, Large-Core Needle; D001941:Breast Diseases / Q000473:pathology* / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D019370:Observation; D061214:Patient Safety; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013781:Texas