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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2011

01-03-2011 | Breast Oncology

Atypical Ductal Hyperplasia in Directional Vacuum-Assisted Biopsy of Breast Microcalcifications: Considerations for Surgical Excision

Authors: Christopher V. Nguyen, MD, Constance T. Albarracin, MD, Gary J. Whitman, MD, Adriana Lopez, MS, Nour Sneige, MD

Published in: Annals of Surgical Oncology | Issue 3/2011

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Abstract

Background

Our goal was to analyze clinicopathologic features of patients with atypical ductal hyperplasia (ADH) diagnosed on directional vacuum-assisted biopsy (DVAB) targeting microcalcifications to identify factors predicting the presence of carcinoma.

Materials and Methods

We retrospectively evaluated the clinical, mammographic, and histologic features of 140 patients with DVAB-diagnosed ADH who underwent either segmental excision (86.4%) or mammographic follow-up (≥2 years; 13.6%). Cases with mass lesions or ipsilateral cancer were excluded.

Results

In 16 cases, carcinoma was found on excision. All cases without excision showed no new abnormalities on mammographic follow-up. Only the amount of calcifications removed (≤95%) significantly correlated with the rate of upgrade of ADH to carcinoma (P = .037). Significant histologic predictors of upgrade to carcinoma included number of terminal duct-lobular units (TDLU; >2) involved (P = .0306), presence of significant cytologic atypia suspicious for intermediate or high-grade carcinoma (P < .0001), and necrosis (P = .0006). Among ADH cases without significant atypia and/or necrosis, the extent of ADH (≤2 vs. >2 TDLU involved) was not a significant predictor of carcinoma (P = 1.0000).

Conclusions

ADH associated with calcifications in the absence of a mass lesion can be categorized into different risk groups using a multidisciplinary approach with correlation of histologic and mammographic findings. ADH lesions with significant cytologic atypia and/or necrosis are most likely to be associated with carcinoma and should be excised. ADH without these features, regardless of extent of involvement, and with >95% removal of the targeted calcifications, is associated with a minimal risk (<3%) of carcinoma and may undergo mammographic follow-up only.
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Metadata
Title
Atypical Ductal Hyperplasia in Directional Vacuum-Assisted Biopsy of Breast Microcalcifications: Considerations for Surgical Excision
Authors
Christopher V. Nguyen, MD
Constance T. Albarracin, MD
Gary J. Whitman, MD
Adriana Lopez, MS
Nour Sneige, MD
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 3/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1127-8

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