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Atypical ductal hyperplasia on core needle biopsy: Development of a predictive model stratifying carcinoma upgrade risk on excision.
Breast J. 2019 01; 25(1):56-61.BJ

Abstract

BACKGROUND

Although the rate of carcinoma upgrade for atypical ductal hyperplasia (ADH) diagnosed on core needle biopsy (CNB) is variable, current standard treatment consists of surgical excision (SE) for all ADH CNB diagnoses. Our objective was to identify features of ADH on CNB that may stratify carcinoma upgrade risk on SE.

METHODS

We retrospectively analyzed cases diagnosed as ADH on CNB. An independent slide review and detailed analysis of radiological and clinical data was performed. Statistical analyses were used to identify predictors for upgrade. Using variables predictive of upgrade, a model to stratify the probability of upgrade of ADH diagnosed on CNB was constructed.

RESULTS

We identified 124 ADH cases with subsequent SE. Of these, 62 cases (50%) were upgraded to carcinoma. Features predictive of upgrade were as follows: diagnosis of "At least ADH", percentage of cores involved by ADH, radiologic lesion size, presence of ipsilateral carcinoma, and patient age. A 4-tiered predictive model using percentage of cores involved by ADH, histologic extent of ADH, radiologic lesion size, and patient age was constructed. This predictive model has a fair accuracy, with an area under the ROC curve of 0.76.

CONCLUSION

We have identified several predictors of carcinoma upgrade for ADH diagnosed on CNB. Our predictive model may be used to stratify the risk of carcinoma upgrade on SE.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. Division of Anatomic Pathology, Sunnybrook Health Science Centre, Toronto, Canada.

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. Division of Anatomic Pathology, Sunnybrook Health Science Centre, Toronto, Canada.

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. Division of Anatomic Pathology, Sunnybrook Health Science Centre, Toronto, Canada.

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. Division of Anatomic Pathology, Sunnybrook Health Science Centre, Toronto, Canada.

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. Division of Anatomic Pathology, Sunnybrook Health Science Centre, Toronto, Canada.

MeSH

Biopsy, Large-Core NeedleBreast NeoplasmsCarcinoma, Ductal, BreastCarcinoma, Intraductal, NoninfiltratingFemaleHumansMiddle AgedMultivariate AnalysisROC CurveRetrospective Studies

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30461131

Citation

Salagean, Elena Diana, et al. "Atypical Ductal Hyperplasia On Core Needle Biopsy: Development of a Predictive Model Stratifying Carcinoma Upgrade Risk On Excision." The Breast Journal, vol. 25, no. 1, 2019, pp. 56-61.

Salagean ED, Slodkowska E, Nofech-Mozes S, et al. Atypical ductal hyperplasia on core needle biopsy: Development of a predictive model stratifying carcinoma upgrade risk on excision. Breast J. 2019;25(1):56-61.

Salagean, E. D., Slodkowska, E., Nofech-Mozes, S., Hanna, W., Parra-Herran, C., & Lu, F. I. (2019). Atypical ductal hyperplasia on core needle biopsy: Development of a predictive model stratifying carcinoma upgrade risk on excision. The Breast Journal, 25(1), 56-61. https://doi.org/10.1111/tbj.13155

Salagean ED, et al. Atypical Ductal Hyperplasia On Core Needle Biopsy: Development of a Predictive Model Stratifying Carcinoma Upgrade Risk On Excision. Breast J. 2019;25(1):56-61. PubMed PMID: 30461131.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Atypical ductal hyperplasia on core needle biopsy: Development of a predictive model stratifying carcinoma upgrade risk on excision. AU - Salagean,Elena Diana, AU - Slodkowska,Elzbieta, AU - Nofech-Mozes,Sharon, AU - Hanna,Wedad, AU - Parra-Herran,Carlos, AU - Lu,Fang-I, Y1 - 2018/11/20/ PY - 2017/08/14/received PY - 2018/05/02/revised PY - 2018/05/07/accepted PY - 2018/11/22/pubmed PY - 2019/9/14/medline PY - 2018/11/22/entrez KW - atypical ductal hyperplasia KW - carcinoma upgrade KW - core needle biopsy KW - predictive model SP - 56 EP - 61 JF - The breast journal JO - Breast J VL - 25 IS - 1 N2 - BACKGROUND: Although the rate of carcinoma upgrade for atypical ductal hyperplasia (ADH) diagnosed on core needle biopsy (CNB) is variable, current standard treatment consists of surgical excision (SE) for all ADH CNB diagnoses. Our objective was to identify features of ADH on CNB that may stratify carcinoma upgrade risk on SE. METHODS: We retrospectively analyzed cases diagnosed as ADH on CNB. An independent slide review and detailed analysis of radiological and clinical data was performed. Statistical analyses were used to identify predictors for upgrade. Using variables predictive of upgrade, a model to stratify the probability of upgrade of ADH diagnosed on CNB was constructed. RESULTS: We identified 124 ADH cases with subsequent SE. Of these, 62 cases (50%) were upgraded to carcinoma. Features predictive of upgrade were as follows: diagnosis of "At least ADH", percentage of cores involved by ADH, radiologic lesion size, presence of ipsilateral carcinoma, and patient age. A 4-tiered predictive model using percentage of cores involved by ADH, histologic extent of ADH, radiologic lesion size, and patient age was constructed. This predictive model has a fair accuracy, with an area under the ROC curve of 0.76. CONCLUSION: We have identified several predictors of carcinoma upgrade for ADH diagnosed on CNB. Our predictive model may be used to stratify the risk of carcinoma upgrade on SE. SN - 1524-4741 UR - https://www.unboundmedicine.com/medline/citation/30461131/Atypical_ductal_hyperplasia_on_core_needle_biopsy:_Development_of_a_predictive_model_stratifying_carcinoma_upgrade_risk_on_excision_ DB - PRIME DP - Unbound Medicine ER -