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Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia.
Breast Cancer Res Treat. 2017 Jul; 164(2):295-304.BC

Abstract

PURPOSE

Atypical ductal hyperplasia (ADH) identified on percutaneous breast biopsy represents a high-risk lesion, upgrading to cancer with surgical excision in ~7-45.8% of cases. Routine excision is questioned due to potential overtreatment and cost. This study evaluates clinical, imaging, and histologic features to predict the risk of upgrade.

METHODS

With IRB approval, a single-institution retrospective review was performed of patients who underwent surgical excision of ADH diagnosed by core biopsy from June 2005 to June 2013. We reviewed electronic medical records, breast imaging, and biopsy slides. Multiple imputation was used for missing data. Association of various features with cancer upgrade was assessed using logistic regression.

RESULTS

Among 399 cases, the upgrade rate to cancer was 16.0%, (95% CI: 12.8-20.0%), with nine invasive cancers and 55 ductal carcinoma in situ (DCIS) only. Via a logistic regression approach, we defined a subgroup with low risk for upgrade: women whose biopsies showed no individual cell necrosis, and either a) 1 focus of ADH with ≥50% removal, or b) 2-3 foci with ≥90% removal. Cases meeting these criteria had an upgrade rate of 4.9% (95% CI: 1.0-8.9%), compared to 21.4% (16.4-26.3%) in cases that did not meet this low-risk definition.

CONCLUSIONS

ADH on core biopsy with low risk of upgrade to cancer is defined by lack of individual cell necrosis, number of foci of ADH, and percent of imaging lesion removed. If these findings are validated, women whose biopsies meet low-risk criteria might be considered for prevention therapy and surveillance without surgical excision.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Peña A
Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Shah SS
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
Fazzio RT
Department of Diagnostic Radiology, Division of Breast Imaging, Mayo Clinic, Rochester, MN, 55905, USA.
Hoskin TL
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
Brahmbhatt RD
Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Hieken TJ
Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Jakub JW
Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Boughey JC
Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Visscher DW
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
Degnim AC
Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. degnim.amy@mayo.edu.

MeSH

AdultAgedAged, 80 and overBiopsy, Large-Core NeedleBreastBreast NeoplasmsCarcinoma, Intraductal, NoninfiltratingFemaleHumansLogistic ModelsMiddle AgedRetrospective StudiesRisk Factors

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28474262

Citation

Peña, Alvaro, et al. "Multivariate Model to Identify Women at Low Risk of Cancer Upgrade After a Core Needle Biopsy Diagnosis of Atypical Ductal Hyperplasia." Breast Cancer Research and Treatment, vol. 164, no. 2, 2017, pp. 295-304.
Peña A, Shah SS, Fazzio RT, et al. Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia. Breast Cancer Res Treat. 2017;164(2):295-304.
Peña, A., Shah, S. S., Fazzio, R. T., Hoskin, T. L., Brahmbhatt, R. D., Hieken, T. J., Jakub, J. W., Boughey, J. C., Visscher, D. W., & Degnim, A. C. (2017). Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia. Breast Cancer Research and Treatment, 164(2), 295-304. https://doi.org/10.1007/s10549-017-4253-1
Peña A, et al. Multivariate Model to Identify Women at Low Risk of Cancer Upgrade After a Core Needle Biopsy Diagnosis of Atypical Ductal Hyperplasia. Breast Cancer Res Treat. 2017;164(2):295-304. PubMed PMID: 28474262.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia. AU - Peña,Alvaro, AU - Shah,Sejal S, AU - Fazzio,Robert T, AU - Hoskin,Tanya L, AU - Brahmbhatt,Rushin D, AU - Hieken,Tina J, AU - Jakub,James W, AU - Boughey,Judy C, AU - Visscher,Daniel W, AU - Degnim,Amy C, Y1 - 2017/05/04/ PY - 2017/01/17/received PY - 2017/04/17/accepted PY - 2017/5/6/pubmed PY - 2018/3/21/medline PY - 2017/5/6/entrez KW - Atypical ductal hyperplasia KW - Breast cancer KW - Core needle biopsy KW - Upgrade SP - 295 EP - 304 JF - Breast cancer research and treatment JO - Breast Cancer Res Treat VL - 164 IS - 2 N2 - PURPOSE: Atypical ductal hyperplasia (ADH) identified on percutaneous breast biopsy represents a high-risk lesion, upgrading to cancer with surgical excision in ~7-45.8% of cases. Routine excision is questioned due to potential overtreatment and cost. This study evaluates clinical, imaging, and histologic features to predict the risk of upgrade. METHODS: With IRB approval, a single-institution retrospective review was performed of patients who underwent surgical excision of ADH diagnosed by core biopsy from June 2005 to June 2013. We reviewed electronic medical records, breast imaging, and biopsy slides. Multiple imputation was used for missing data. Association of various features with cancer upgrade was assessed using logistic regression. RESULTS: Among 399 cases, the upgrade rate to cancer was 16.0%, (95% CI: 12.8-20.0%), with nine invasive cancers and 55 ductal carcinoma in situ (DCIS) only. Via a logistic regression approach, we defined a subgroup with low risk for upgrade: women whose biopsies showed no individual cell necrosis, and either a) 1 focus of ADH with ≥50% removal, or b) 2-3 foci with ≥90% removal. Cases meeting these criteria had an upgrade rate of 4.9% (95% CI: 1.0-8.9%), compared to 21.4% (16.4-26.3%) in cases that did not meet this low-risk definition. CONCLUSIONS: ADH on core biopsy with low risk of upgrade to cancer is defined by lack of individual cell necrosis, number of foci of ADH, and percent of imaging lesion removed. If these findings are validated, women whose biopsies meet low-risk criteria might be considered for prevention therapy and surveillance without surgical excision. SN - 1573-7217 UR - https://www.unboundmedicine.com/medline/citation/28474262/Multivariate_model_to_identify_women_at_low_risk_of_cancer_upgrade_after_a_core_needle_biopsy_diagnosis_of_atypical_ductal_hyperplasia_ L2 - https://doi.org/10.1007/s10549-017-4253-1 DB - PRIME DP - Unbound Medicine ER -