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Type of Architecture, Presence of Punctate Necrosis, and Extent of Involvement in Atypical Ductal Hyperplasia Can Predict the Diagnosis of Breast Carcinoma on Excision: A Clinicopathologic Study of 143 Cases.
Int J Surg Pathol. 2021 Oct; 29(7):716-721.IJ

Abstract

The literature shows a wide range in the frequencies of finding breast carcinoma in the excised specimens following a biopsy diagnosis of atypical ductal hyperplasia (ADH), likely due to a poor diagnostic reproducibility among different pathologists as well as an inherent heterogeneity in ADH. We evaluated whether histologic subtyping of ADH would help predict the risk of breast carcinoma. Our study consisted of 143 cases of ADH diagnosed by core needle biopsy and followed by excision. Of these, 54 cases (37.8%) showed carcinoma in the excised specimens (47 cases of ductal carcinoma in situ alone, 3 cases of invasive ductal carcinoma alone, and 4 cases of mixed invasive ductal carcinoma and ductal carcinoma in situ). We arbitrarily divided ADH into two subtypes: type A was considered when one or more ducts were completely replaced by low-grade ductal carcinoma in situ type cells but the lesion was <2 mm and type B was considered when one or more ducts were partially involved by low-grade ductal carcinoma in situ type cells regardless of lesion size. Type A was associated with a significantly higher frequency of breast carcinoma (63.6%) than type B (30.0%). ADH containing punctate necrosis showed a higher association of carcinoma (66.7%) compared to those without necrosis (35.1%). Within type B ADH, involvement of 3 or more foci had a higher frequency of carcinoma (50.0%) than involvement of fewer foci (26.6%). These histologic features of ADH may prove useful in predicting the likelihood of breast carcinoma and provide helpful information for patient's management.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Zhang C
Kent Hospital, Warwick, RI, USA. 22209Women & Infants Hospital of Rhode Island, Providence, RI, USA. Warren Alpert Medical School, 6752Brown University, Providence, RI, USA.
Wang EY
22209Women & Infants Hospital of Rhode Island, Providence, RI, USA. Now with Meditech, One Constitution Way, Foxborough, MA, USA.
Liu F
22209Women & Infants Hospital of Rhode Island, Providence, RI, USA. Warren Alpert Medical School, 6752Brown University, Providence, RI, USA. Now with Saint Vincent Hospital, Worcester Medical Center, Worcester, MA, USA.
Ruhul Quddus M
22209Women & Infants Hospital of Rhode Island, Providence, RI, USA. Warren Alpert Medical School, 6752Brown University, Providence, RI, USA.
James Sung C
22209Women & Infants Hospital of Rhode Island, Providence, RI, USA. Warren Alpert Medical School, 6752Brown University, Providence, RI, USA.

MeSH

AdultAgedAged, 80 and overBiopsy, Large-Core NeedleBreast NeoplasmsCarcinoma, Ductal, BreastCarcinoma, Intraductal, NoninfiltratingFemaleHumansHyperplasiaMammary Glands, HumanMastectomy, SegmentalMiddle AgedNecrosisPrognosisReproducibility of ResultsRisk Assessment

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

33881947

Citation

Zhang, Cunxian, et al. "Type of Architecture, Presence of Punctate Necrosis, and Extent of Involvement in Atypical Ductal Hyperplasia Can Predict the Diagnosis of Breast Carcinoma On Excision: a Clinicopathologic Study of 143 Cases." International Journal of Surgical Pathology, vol. 29, no. 7, 2021, pp. 716-721.
Zhang C, Wang EY, Liu F, et al. Type of Architecture, Presence of Punctate Necrosis, and Extent of Involvement in Atypical Ductal Hyperplasia Can Predict the Diagnosis of Breast Carcinoma on Excision: A Clinicopathologic Study of 143 Cases. Int J Surg Pathol. 2021;29(7):716-721.
Zhang, C., Wang, E. Y., Liu, F., Ruhul Quddus, M., & James Sung, C. (2021). Type of Architecture, Presence of Punctate Necrosis, and Extent of Involvement in Atypical Ductal Hyperplasia Can Predict the Diagnosis of Breast Carcinoma on Excision: A Clinicopathologic Study of 143 Cases. International Journal of Surgical Pathology, 29(7), 716-721. https://doi.org/10.1177/10668969211010954
Zhang C, et al. Type of Architecture, Presence of Punctate Necrosis, and Extent of Involvement in Atypical Ductal Hyperplasia Can Predict the Diagnosis of Breast Carcinoma On Excision: a Clinicopathologic Study of 143 Cases. Int J Surg Pathol. 2021;29(7):716-721. PubMed PMID: 33881947.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Type of Architecture, Presence of Punctate Necrosis, and Extent of Involvement in Atypical Ductal Hyperplasia Can Predict the Diagnosis of Breast Carcinoma on Excision: A Clinicopathologic Study of 143 Cases. AU - Zhang,Cunxian, AU - Wang,Edmond Y, AU - Liu,Fang, AU - Ruhul Quddus,M, AU - James Sung,C, Y1 - 2021/04/21/ PY - 2021/4/22/pubmed PY - 2022/1/18/medline PY - 2021/4/21/entrez KW - atypical ductal hyperplasia KW - breast carcinoma KW - core needle biopsy KW - predict the likelihood KW - routine histologic features SP - 716 EP - 721 JF - International journal of surgical pathology JO - Int J Surg Pathol VL - 29 IS - 7 N2 - The literature shows a wide range in the frequencies of finding breast carcinoma in the excised specimens following a biopsy diagnosis of atypical ductal hyperplasia (ADH), likely due to a poor diagnostic reproducibility among different pathologists as well as an inherent heterogeneity in ADH. We evaluated whether histologic subtyping of ADH would help predict the risk of breast carcinoma. Our study consisted of 143 cases of ADH diagnosed by core needle biopsy and followed by excision. Of these, 54 cases (37.8%) showed carcinoma in the excised specimens (47 cases of ductal carcinoma in situ alone, 3 cases of invasive ductal carcinoma alone, and 4 cases of mixed invasive ductal carcinoma and ductal carcinoma in situ). We arbitrarily divided ADH into two subtypes: type A was considered when one or more ducts were completely replaced by low-grade ductal carcinoma in situ type cells but the lesion was <2 mm and type B was considered when one or more ducts were partially involved by low-grade ductal carcinoma in situ type cells regardless of lesion size. Type A was associated with a significantly higher frequency of breast carcinoma (63.6%) than type B (30.0%). ADH containing punctate necrosis showed a higher association of carcinoma (66.7%) compared to those without necrosis (35.1%). Within type B ADH, involvement of 3 or more foci had a higher frequency of carcinoma (50.0%) than involvement of fewer foci (26.6%). These histologic features of ADH may prove useful in predicting the likelihood of breast carcinoma and provide helpful information for patient's management. SN - 1940-2465 UR - https://www.unboundmedicine.com/medline/citation/33881947/Type_of_Architecture_Presence_of_Punctate_Necrosis_and_Extent_of_Involvement_in_Atypical_Ductal_Hyperplasia_Can_Predict_the_Diagnosis_of_Breast_Carcinoma_on_Excision:_A_Clinicopathologic_Study_of_143_Cases_ DB - PRIME DP - Unbound Medicine ER -