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Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation.
AJR Am J Roentgenol. 2014 Jun; 202(6):1389-94.AA

Abstract

OBJECTIVE

The purposes of this article were to review the mammographic and sonographic features of breast masses yielding atypical ductal hyperplasia (ADH) at sonographically guided biopsy, evaluate the surgical pathology outcome of these lesions, and determine whether clinical or imaging features can be used to predict upgrade to malignancy.

MATERIALS AND METHODS

Among 6325 sonographically guided biopsies (2003- 2010) (14-gauge cores), 56 yielded the diagnosis of ADH (0.9%). Six patients were excluded (lost to follow-up). Fifty lesions were surgically excised in 45 patients. Mammographic and sonographic features were analyzed in consensus by two radiologists using the BI-RADS lexicon.

RESULTS

Forty-five patients (mean age, 56 years; 12 < 50 years; six with synchronous breast carcinoma) had 50 ADH lesions (median size, 0.6 cm). Surgical excision yielded malignancy in 28 cases (56% underestimation rate). Among 42 mammograms (47 lesions), 30 lesions were identified (30/47, 64%) as masses (12/30, 40%), asymmetric densities (10/30, 33%), microcalcifications (4/30, 13%), and architectural distortions (4/30, 13%). Sonographically, most lesions appeared as hypoechoic masses (64%, 30/47) with irregular shape (51%, 24/47), microlobulated margins (49%, 23/47), no posterior acoustic feature (25/47, 53%), abrupt interface (70%, 33/47), and parallel orientation (57%, 27/47). No mammographic and sonographic features were associated with malignant outcome, whereas age less than 50 years (p = 0.03) and synchronous malignancy (p = 0.03) were associated with malignant outcome.

CONCLUSION

ADH diagnosed at sonographically guided 14-gauge core needle biopsy shows a high underestimation rate. Synchronous carcinoma or age less than 50 years is associated with malignant outcome.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Mesurolle B
1 All authors: Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Ave W, Montreal, PQ, H3H 1A1 Canada.
Perez JC
No affiliation info available
Azzumea F
No affiliation info available
Lemercier E
No affiliation info available
Xie X
No affiliation info available
Aldis A
No affiliation info available
Omeroglu A
No affiliation info available
Meterissian S
No affiliation info available

MeSH

Biopsy, Large-Core NeedleBreast NeoplasmsCarcinoma, Intraductal, NoninfiltratingEndoscopic Ultrasound-Guided Fine Needle AspirationFalse Negative ReactionsFemaleHumansIncidenceMiddle AgedPrecancerous ConditionsQuebecReproducibility of ResultsRisk FactorsSensitivity and SpecificityTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24848840

Citation

Mesurolle, Benoît, et al. "Atypical Ductal Hyperplasia Diagnosed at Sonographically Guided Core Needle Biopsy: Frequency, Final Surgical Outcome, and Factors Associated With Underestimation." AJR. American Journal of Roentgenology, vol. 202, no. 6, 2014, pp. 1389-94.
Mesurolle B, Perez JC, Azzumea F, et al. Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation. AJR Am J Roentgenol. 2014;202(6):1389-94.
Mesurolle, B., Perez, J. C., Azzumea, F., Lemercier, E., Xie, X., Aldis, A., Omeroglu, A., & Meterissian, S. (2014). Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation. AJR. American Journal of Roentgenology, 202(6), 1389-94. https://doi.org/10.2214/AJR.13.10864
Mesurolle B, et al. Atypical Ductal Hyperplasia Diagnosed at Sonographically Guided Core Needle Biopsy: Frequency, Final Surgical Outcome, and Factors Associated With Underestimation. AJR Am J Roentgenol. 2014;202(6):1389-94. PubMed PMID: 24848840.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation. AU - Mesurolle,Benoît, AU - Perez,Juan Carlos Hidalgo, AU - Azzumea,Fahad, AU - Lemercier,Emmanuelle, AU - Xie,Xuanqian, AU - Aldis,Ann, AU - Omeroglu,Atilla, AU - Meterissian,Sarkis, PY - 2014/5/23/entrez PY - 2014/5/23/pubmed PY - 2014/7/12/medline SP - 1389 EP - 94 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 202 IS - 6 N2 - OBJECTIVE: The purposes of this article were to review the mammographic and sonographic features of breast masses yielding atypical ductal hyperplasia (ADH) at sonographically guided biopsy, evaluate the surgical pathology outcome of these lesions, and determine whether clinical or imaging features can be used to predict upgrade to malignancy. MATERIALS AND METHODS: Among 6325 sonographically guided biopsies (2003- 2010) (14-gauge cores), 56 yielded the diagnosis of ADH (0.9%). Six patients were excluded (lost to follow-up). Fifty lesions were surgically excised in 45 patients. Mammographic and sonographic features were analyzed in consensus by two radiologists using the BI-RADS lexicon. RESULTS: Forty-five patients (mean age, 56 years; 12 < 50 years; six with synchronous breast carcinoma) had 50 ADH lesions (median size, 0.6 cm). Surgical excision yielded malignancy in 28 cases (56% underestimation rate). Among 42 mammograms (47 lesions), 30 lesions were identified (30/47, 64%) as masses (12/30, 40%), asymmetric densities (10/30, 33%), microcalcifications (4/30, 13%), and architectural distortions (4/30, 13%). Sonographically, most lesions appeared as hypoechoic masses (64%, 30/47) with irregular shape (51%, 24/47), microlobulated margins (49%, 23/47), no posterior acoustic feature (25/47, 53%), abrupt interface (70%, 33/47), and parallel orientation (57%, 27/47). No mammographic and sonographic features were associated with malignant outcome, whereas age less than 50 years (p = 0.03) and synchronous malignancy (p = 0.03) were associated with malignant outcome. CONCLUSION: ADH diagnosed at sonographically guided 14-gauge core needle biopsy shows a high underestimation rate. Synchronous carcinoma or age less than 50 years is associated with malignant outcome. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/24848840/Atypical_ductal_hyperplasia_diagnosed_at_sonographically_guided_core_needle_biopsy:_frequency_final_surgical_outcome_and_factors_associated_with_underestimation_ DB - PRIME DP - Unbound Medicine ER -