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Diagnostic upgrade of atypical ductal hyperplasia of the breast based on evaluation of histopathological features and calcification on core needle biopsy.
Histopathology. 2019 Sep; 75(3):320-328.H

Abstract

AIMS

Atypical ductal hyperplasia (ADH) of breast is increasingly diagnosed in core needle biopsy (CNB). As higher-grade lesions were found in the excision in a substantial proportion of ADH on CNB, factors predicting risk of subsequent upgrade are clinically significant. This study aims to investigate relevant histopathological factors in CNB that could predict diagnostic upgrade at excision.

METHODS AND RESULTS

One hundred and forty-three cases of CNB with paired subsequent excision were evaluated for multiple clinicopathological parameters related to CNB sampling, ADH morphology, calcification and other co-existing histological features, and which of these parameters were associated with diagnostic upgrade at subsequent excisions were determined. Forty-eight cases (34.3%) were upgraded to malignancy, including 15 invasive cancers and 33 ductal carcinomas in situ (DCIS). An increased tissue area occupied by ADH (P = 0.026), a higher number of ADH foci (P = 0.004), the presence of solid pattern (P = 0.037) and older age (P = 0.012) were positively associated with upgrade, while negative associations were found with the presence of micropapillary pattern (P = 0.025), co-existing columnar cell lesions (CCL) (P = 0.001) and the presence of calcifications (P = 0.009). Multivariate logistic regression analysis showed that the number of ADH foci (HR = 2.810, P = 0.013) was an independent positive predictor, while co-existing CCL (HR = 0.391, P = 0.013) was an independent negative predictor for upgrade.

CONCLUSIONS

Patients with ADH in CNB showing the presence of co-existing CCL and a lower number of ADH foci have a lower risk of disease upgrade at excision, and are potential candidates for observation-only management.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Chen LY
Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Hu J
Department of Pathology, Shenzhen People's Hospital, Shenzhen, China.
Tsang JYS
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Lee MA
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Ni YB
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Chan SK
Department of Pathology, Kwong Wah Hospital, Hong Kong, China.
Tse GMK
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.

MeSH

AdultAgedBiopsy, Large-Core NeedleBreast NeoplasmsCalcinosisCarcinoma, Intraductal, NoninfiltratingFemaleHumansMiddle Aged

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31013355

Citation

Chen, Lin-Ying, et al. "Diagnostic Upgrade of Atypical Ductal Hyperplasia of the Breast Based On Evaluation of Histopathological Features and Calcification On Core Needle Biopsy." Histopathology, vol. 75, no. 3, 2019, pp. 320-328.
Chen LY, Hu J, Tsang JYS, et al. Diagnostic upgrade of atypical ductal hyperplasia of the breast based on evaluation of histopathological features and calcification on core needle biopsy. Histopathology. 2019;75(3):320-328.
Chen, L. Y., Hu, J., Tsang, J. Y. S., Lee, M. A., Ni, Y. B., Chan, S. K., & Tse, G. M. K. (2019). Diagnostic upgrade of atypical ductal hyperplasia of the breast based on evaluation of histopathological features and calcification on core needle biopsy. Histopathology, 75(3), 320-328. https://doi.org/10.1111/his.13881
Chen LY, et al. Diagnostic Upgrade of Atypical Ductal Hyperplasia of the Breast Based On Evaluation of Histopathological Features and Calcification On Core Needle Biopsy. Histopathology. 2019;75(3):320-328. PubMed PMID: 31013355.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic upgrade of atypical ductal hyperplasia of the breast based on evaluation of histopathological features and calcification on core needle biopsy. AU - Chen,Lin-Ying, AU - Hu,Jintao, AU - Tsang,Julia Y S, AU - Lee,Michelle A, AU - Ni,Yun-Bi, AU - Chan,Siu-Ki, AU - Tse,Gary M K, Y1 - 2019/07/16/ PY - 2019/01/09/received PY - 2019/03/27/revised PY - 2019/04/19/accepted PY - 2019/4/24/pubmed PY - 2020/2/23/medline PY - 2019/4/24/entrez KW - atypical ductal hyperplasia KW - breast cancer KW - core needle biopsy KW - malignant upgrade SP - 320 EP - 328 JF - Histopathology JO - Histopathology VL - 75 IS - 3 N2 - AIMS: Atypical ductal hyperplasia (ADH) of breast is increasingly diagnosed in core needle biopsy (CNB). As higher-grade lesions were found in the excision in a substantial proportion of ADH on CNB, factors predicting risk of subsequent upgrade are clinically significant. This study aims to investigate relevant histopathological factors in CNB that could predict diagnostic upgrade at excision. METHODS AND RESULTS: One hundred and forty-three cases of CNB with paired subsequent excision were evaluated for multiple clinicopathological parameters related to CNB sampling, ADH morphology, calcification and other co-existing histological features, and which of these parameters were associated with diagnostic upgrade at subsequent excisions were determined. Forty-eight cases (34.3%) were upgraded to malignancy, including 15 invasive cancers and 33 ductal carcinomas in situ (DCIS). An increased tissue area occupied by ADH (P = 0.026), a higher number of ADH foci (P = 0.004), the presence of solid pattern (P = 0.037) and older age (P = 0.012) were positively associated with upgrade, while negative associations were found with the presence of micropapillary pattern (P = 0.025), co-existing columnar cell lesions (CCL) (P = 0.001) and the presence of calcifications (P = 0.009). Multivariate logistic regression analysis showed that the number of ADH foci (HR = 2.810, P = 0.013) was an independent positive predictor, while co-existing CCL (HR = 0.391, P = 0.013) was an independent negative predictor for upgrade. CONCLUSIONS: Patients with ADH in CNB showing the presence of co-existing CCL and a lower number of ADH foci have a lower risk of disease upgrade at excision, and are potential candidates for observation-only management. SN - 1365-2559 UR - https://www.unboundmedicine.com/medline/citation/31013355/Diagnostic_upgrade_of_atypical_ductal_hyperplasia_of_the_breast_based_on_evaluation_of_histopathological_features_and_calcification_on_core_needle_biopsy_ DB - PRIME DP - Unbound Medicine ER -