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Atypical ductal hyperplasia bordering on DCIS on core biopsy is associated with higher risk of upgrade than conventional atypical ductal hyperplasia.
Breast Cancer Res Treat. 2020 Dec; 184(3):873-880.BC

Abstract

PURPOSE

Upgrade rates of conventional ADH are reported at 10-30%; however, rates for ADH bordering on DCIS (ADH-BD) are largely unknown. We examined the upgrade rate of ADH-BD and core needle biopsy (CNB) features associated with upgrade. Surgical management in patients with concurrent ipsilateral breast cancer (BC) was also examined.

METHODS

From 2000 to 2018, women with CNB diagnosis of ADH-BD were prospectively identified. Women with pure ADH-BD and concurrent ipsilateral ADH-BD/BC were analyzed separately, and upgrade rates were calculated. CNB features associated with upgrade and type of surgery were examined in women with pure ADH-BD; CNB features and concurrent pathology associated with upgrade were examined in women with ipsilateral BC.

RESULTS

108/236 (46%) patients with pure ADH-BD on CNB had DCIS (40%) or invasive carcinoma (6%) on surgical excision. DCIS or invasive carcinoma was more frequently found on excision of a mass that yielded ADH-BD on biopsy than excision of calcifications (65% vs 38%; p < 0.001). The breast conservation success rate was high (80%) in patients who upgraded, despite a high re-excision rate of 46%. The upgrade rate of ADH-BD in women with concurrent ipsilateral BC was 41%. Most women (94%) with ADH-BD in the same quadrant as the BC were candidates for breast conserving surgery, with a success rate of 89%.

CONCLUSION

The upgrade rate for pure ADH-BD is significantly higher than that reported for women with conventional ADH, especially in women with a mass on imaging. The upgrade rate of concurrent ipsilateral ADH-BD and BC is similarly high. Excision with a margin of normal tissue and specimen inking should be routine to minimize the need for re-excision.

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Authors+Show Affiliations

Pawloski KR
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.
Christian N
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.
Knezevic A
Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Wen HY
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Van Zee KJ
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.
Morrow M
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.
Tadros AB
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA. tadrosa@mskcc.org.

MeSH

Biopsy, Large-Core NeedleBreastBreast NeoplasmsCalcinosisCarcinoma, Ductal, BreastCarcinoma, Intraductal, NoninfiltratingFemaleHumansHyperplasia

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32857242

Citation

Pawloski, Kate R., et al. "Atypical Ductal Hyperplasia Bordering On DCIS On Core Biopsy Is Associated With Higher Risk of Upgrade Than Conventional Atypical Ductal Hyperplasia." Breast Cancer Research and Treatment, vol. 184, no. 3, 2020, pp. 873-880.
Pawloski KR, Christian N, Knezevic A, et al. Atypical ductal hyperplasia bordering on DCIS on core biopsy is associated with higher risk of upgrade than conventional atypical ductal hyperplasia. Breast Cancer Res Treat. 2020;184(3):873-880.
Pawloski, K. R., Christian, N., Knezevic, A., Wen, H. Y., Van Zee, K. J., Morrow, M., & Tadros, A. B. (2020). Atypical ductal hyperplasia bordering on DCIS on core biopsy is associated with higher risk of upgrade than conventional atypical ductal hyperplasia. Breast Cancer Research and Treatment, 184(3), 873-880. https://doi.org/10.1007/s10549-020-05890-1
Pawloski KR, et al. Atypical Ductal Hyperplasia Bordering On DCIS On Core Biopsy Is Associated With Higher Risk of Upgrade Than Conventional Atypical Ductal Hyperplasia. Breast Cancer Res Treat. 2020;184(3):873-880. PubMed PMID: 32857242.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atypical ductal hyperplasia bordering on DCIS on core biopsy is associated with higher risk of upgrade than conventional atypical ductal hyperplasia. AU - Pawloski,Kate R, AU - Christian,Nicole, AU - Knezevic,Andrea, AU - Wen,Hannah Y, AU - Van Zee,Kimberly J, AU - Morrow,Monica, AU - Tadros,Audree B, Y1 - 2020/08/28/ PY - 2020/06/30/received PY - 2020/08/17/accepted PY - 2020/8/29/pubmed PY - 2021/6/24/medline PY - 2020/8/29/entrez KW - Atypical ductal hyperplasia KW - Borderline lesions KW - Breast surgery KW - Ductal carcinoma in situ KW - Ipsilateral breast cancer KW - Markedly atypical ductal hyperplasia SP - 873 EP - 880 JF - Breast cancer research and treatment JO - Breast Cancer Res Treat VL - 184 IS - 3 N2 - PURPOSE: Upgrade rates of conventional ADH are reported at 10-30%; however, rates for ADH bordering on DCIS (ADH-BD) are largely unknown. We examined the upgrade rate of ADH-BD and core needle biopsy (CNB) features associated with upgrade. Surgical management in patients with concurrent ipsilateral breast cancer (BC) was also examined. METHODS: From 2000 to 2018, women with CNB diagnosis of ADH-BD were prospectively identified. Women with pure ADH-BD and concurrent ipsilateral ADH-BD/BC were analyzed separately, and upgrade rates were calculated. CNB features associated with upgrade and type of surgery were examined in women with pure ADH-BD; CNB features and concurrent pathology associated with upgrade were examined in women with ipsilateral BC. RESULTS: 108/236 (46%) patients with pure ADH-BD on CNB had DCIS (40%) or invasive carcinoma (6%) on surgical excision. DCIS or invasive carcinoma was more frequently found on excision of a mass that yielded ADH-BD on biopsy than excision of calcifications (65% vs 38%; p < 0.001). The breast conservation success rate was high (80%) in patients who upgraded, despite a high re-excision rate of 46%. The upgrade rate of ADH-BD in women with concurrent ipsilateral BC was 41%. Most women (94%) with ADH-BD in the same quadrant as the BC were candidates for breast conserving surgery, with a success rate of 89%. CONCLUSION: The upgrade rate for pure ADH-BD is significantly higher than that reported for women with conventional ADH, especially in women with a mass on imaging. The upgrade rate of concurrent ipsilateral ADH-BD and BC is similarly high. Excision with a margin of normal tissue and specimen inking should be routine to minimize the need for re-excision. SN - 1573-7217 UR - https://www.unboundmedicine.com/medline/citation/32857242/Atypical_ductal_hyperplasia_bordering_on_DCIS_on_core_biopsy_is_associated_with_higher_risk_of_upgrade_than_conventional_atypical_ductal_hyperplasia_ DB - PRIME DP - Unbound Medicine ER -