Atypical Ductal Hyperplasia Diagnosed at Sonographically Guided 14-Gauge Core Needle Biopsy of Breast Mass (original) (raw)
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Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005
To evaluate breast cancer underestimation rate of atypical ductal hyperplasia (ADH) diagnosed by core-needle biopsy (CNB) under imaging guidance in Ramathibodi Hospital and to determine the difference between the malignant and benign groups in terms of clinical and imaging characteristics. The pathological records of 1521 patients who underwent CNB under imaging guidance were reviewed. Thirty-nine patients diagnosed with ADH were enrolled into the present study. Clinical data, imaging features, biopsy technique and result of excisional biopsy as well as follow-up data were retrospectively reviewed. Of 39 ADH cases, eight (20.5%) were found to have malignancy on subsequent excisional biopsy. The majority of these were ductal carcinoma in situ (DCIS) (62.5%). Lesion categorized as category 5 according to BI-RADS (Breast imaging reporting and data system) was the only feature which was statistically different between the benign and malignant groups. No statistically significant differe...
Research Square (Research Square), 2021
Purpose: Atypical ductal hyperplasia (ADH) is a high risk lesion with an increased risk of developing breast cancer. This study aims to identify factors predictive of malignant upgrade for ADH diagnosed on core needle biopsy (CNB) and to develop a nomogram to facilitate evidence-based decision making. Methods: Retrospective analysis of women with CNB diagnosed ADH at the National Cancer Centre Singapore between 2010 and 2015 was performed. Cox proportional hazards regression was used to identify independent clinical, radiological and histological factors associated with malignant upgrade. A nomogram was constructed and multivariable logistic regression coe cients were used to estimate the predicted probability of upgrade for each factor combination. Combinations with the lowest predicted probabilities (≤5%) were identi ed as low risk. Model sensitivity, speci city, positive and negative predictive values were assessed. Results: From 2010-2015, 238,122 women underwent screening under the national breast cancer screening programme. 29,564 women were recalled and 5742 CNBs were performed, of which 2686 were performed at NCCS. 88 patients (90 lesions) were diagnosed with ADH. 26 lesions were upgraded to a breast malignancy on excision biopsy. On univariate analysis, presence of a mass on either ultrasound (p= 0.018) or mammogram (p=0.026), presence of mammographic microcalci cations (p=0.047), diffuse microcalci cation distribution (p=0.034), mammographic parenchymal density (p=0.008), presence of microcalci cations on biopsy (p=0.037) and three or more separate foci of ADH found on biopsy (p=0.024) were associated with malignant upgrade. Mammographic parenchymal density (Hazard ratio= 0.04, 95% CI 0.005-0.35, p=0.014), presence of a mass on ultrasound (Hazard ratio= 10.50, 95% CI 9.21-25.2, p=0.010) and number of foci of ADH (Hazard ratio = 1.877, 95% CI 1.831-1.920, p=0.002) remained signi cant on multivariate analysis and were included in the normogram which demonstrated good discrimination with C-statistic of 0.81 [95% CI, 0.74 to 0.88]. Conclusion: Our model provides good discrimination of breast cancer risk prediction in patients with ADH on CNB. A subset of women at low risk (<5%) of upgrade to cancer may avoid surgical excision following a core-needle biopsy diagnosis of ADH.
Subsequent Breast Cancer Risk Following Diagnosis of Atypical Ductal Hyperplasia on Needle Biopsy
JAMA Oncology, 2017
Background-Atypical ductal hyperplasia (ADH) is a known strong risk factor for breast cancer. Published risk estimates are based on cohorts that included women diagnosed prior to the widespread use of screening mammograms and do not differentiate between the methods used to diagnose ADH, which may be related to size of the ADH focus. These risks may overestimate the risk of women currently diagnosed with ADH. We sought to examine the risk of invasive cancer associated with ADH diagnosed on core needle biopsy versus excisional biopsy. Design-Cohort study comparing ten-year cumulative risk of invasive breast cancer in women undergoing mammography with and without a diagnosis of ADH. Setting-Five breast imaging registries that participate in the National Cancer Institute-funded Breast Cancer Surveillance Consortium (BCSC). Participants-Women undergoing mammography in the BCSC. Exposure-Diagnosis of ADH on core needle biopsy or excisional biopsy in women undergoing mammography. Main outcome-Ten-year cumulative risk of invasive breast cancer risk.
Radiologia Brasileira, 2016
Objective: To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary objective, the frequency of ADH and DCIS was determined for the cases submitted to biopsy. Materials and Methods: Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis of biopsies performed between February 2011 and July 2013, subsequently submitted to surgery, whose histopathological reports were available in the internal information system. Biopsy results were compared with those observed at surgery and the underestimation rate was calculated by means of specific mathematical equations. Results: The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at VABB it was 25% for ADH and 14.28% for DCIS. A...
Videosurgery and Other Miniinvasive Techniques
Introduction: Atypical ductal hyperplasia (ADH) is a benign lesion, which due to the risk of coexisting cancer is classified as a lesion of uncertain malignant potential. Aim: To identify clinical predictors of cancer underestimation in patients with ADH diagnosed after vacuum-assisted breast biopsy (VABB). Material and methods: Between 2001 and 2016, a total of 3804 vacuum-assisted core needle biopsies were performed at the First Chair of General Surgery of the Jagiellonian University Medical College in Krakow, including 2907 ultrasound (US)-guided biopsies and 897 digital stereotactic procedures. Seventy-six women were diagnosed with ADH and 72 of them underwent subsequent surgical excision. Demographic factors, medical history, family history, clinical symptoms, type and size of lesion determined in imaging scans, size of biopsy needle, and presence of coexisting lesions in VABB specimens were analysed as potential predictors of malignancy underestimation. Results: Underestimation of breast carcinoma occurred in 21 (29.2%) patients. The upgrade rate was significantly higher only in patients with a lesion visible both in mammography (MMG) and US examinations and combined BIRADS-5. Conclusions: Vacuum-assisted core needle biopsy is a minimally invasive technique used in diagnosing ADH. As the risk of breast malignancy underestimation is relatively high, open surgical biopsy remains the recommended procedure, especially in patients with lesions detected both in mammography and US examination. As we could not identify the factors that preclude cancer underestimation, all the women diagnosed with ADH should be informed about the risk of cancer underestimation.
The Breast, 2008
The incidence of malignancy in excision biopsies performed for atypical ductal hyperplasia (ADH) diagnosed on needle biopsies has decreased since the advent of larger tissue sampling and improved accuracy using vacuum-assisted Mammotome biopsy. We undertook a retrospective study to identify predictive factors for understaging of ADH diagnosed on 11-gauge Mammotome biopsy, to determine whether it was possible to avoid surgical excision in women where mammographically visible calcifications had been completely removed. Sixty-one biopsy diagnosed ADH lesions were correlated with surgical excision findings that revealed DCIS in 14 (23%). The mammographic and biopsy features were statistically analyzed using Fisher's exact test. There was no association between morphology, extent of calcifications, number of cores sampled with underestimation of malignancy (P ¼ 0.503, 0.709, 0.551 respectively). In the absence of residual calcifications, the frequency of underestimation of carcinoma still occurred in 17%.
Diagnostic accuracy of ultrasonography-guided core needle biopsy for breast lesions
Singapore medical journal, 2012
This study aimed to assess the diagnostic accuracy of ultrasonography (US)-guided core needle biopsy (CNB) for breast lesions. We performed US-guided CNB of 733 lesions in 674 women from January 2003 to December 2005. Surgical excision was performed on 331 lesions. We compared the histopathologic findings of the CNB specimens with those of surgical specimens or with patients' long-term follow-up images. We also calculated the agreement, underestimation, sensitivity and false-negative rates. The CNB results showed 334 breast cancers (46%), 28 high-risk lesions (5%) and 367 benign lesions (50%). Four (1%) lesions were categorised as inconclusive. The final diagnosis was breast cancer in 348 lesions. The kappa measure of agreement between the US-guided CNB results and surgical excision findings or follow-up results was 0.861 (p-value < 0.001). The underestimation rate was 40% (10 out of 25) for atypical ductal hyperplasia and 47% (14 out of 30) for ductal carcinoma in situ (DCIS...
American Journal of Surgery, 2019
Objectives: The increasing accuracy of large-bore (11-or 8-gauge) vacuum-assisted core needle biopsies (VACNB) has challenged the commonly-accepted practice that surgery is needed for definitive diagnosis when atypical ductal hyperplasia (ADH) is found on VACNB. This study seeks to demonstrate the impact of increased VACNB caliber on the pathologic upgrade rate of ADH. Methods: Patients diagnosed with isolated ADH by VACNB who subsequently underwent surgical excision at our tertiary medical center were retrospectively studied. Demographics, needle gauge, number of needle passes, and pathology results were analyzed. Results: From June 1996 to June 2016, approximately 3,740 VACNBs were performed. 139 patients were diagnosed with isolated ADH on VACNB and underwent surgical excision. 30 patients (22%) were upgraded to ductal carcinoma in-situ or invasive cancer; 17 upgrades (21%) from 11-gauge CNB vs. 13 upgrades (23%) from 8-gauge CNB (p=0.67). Conclusion: Increasing core needle biopsy size from 11g to 8g does not decrease the rate of pathologic upstaging at the time of surgical excision. Surgical excision of ADH is still required for complete diagnosis.