Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia

2017 ◽  
Vol 164 (2) ◽  
pp. 295-304 ◽  
Author(s):  
Alvaro Peña ◽  
Sejal S. Shah ◽  
Robert T. Fazzio ◽  
Tanya L. Hoskin ◽  
Rushin D. Brahmbhatt ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Multivariate Model ◽  
Low Risk ◽  
Core Needle ◽  
Biopsy Diagnosis ◽  
Ductal Hyperplasia ◽  
Risk Of Cancer

A multivariate model to predict cancer upgrade from atypical ductal hyperplasia by core needle biopsy.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 3-3 ◽  
Author(s):  
Alvaro Pena ◽  
Robert T. Fazzio ◽  
Sejal Shah ◽  
Tanya L. Hoskin ◽  
Rushin D Brahmbhatt ◽  
...  
Keyword(s):  
Needle Biopsy ◽  
Core Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Individual Cell ◽  
Surgical Excision ◽  
Multivariate Model ◽  
Low Risk ◽  
Cell Necrosis ◽  
Core Needle ◽  
Ductal Hyperplasia

3 Background: Atypical ductal hyperplasia (ADH) is a high-risk breast lesion usually diagnosed with core needle biopsy. Although upgraded to cancer at surgical excision in ~15 to 25% of cases, routine excision is questioned due to cost and overtreatment. We evaluated clinical, imaging, and histologic features associated with cancer upgrade and developed a multivariate model to predict 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 06/2005 to 06/2013. Review was performed of electronic records, breast imagin,g and biopsy slides. Multiple imputations were used for missing data. Association of cancer upgrade with various features was assessed with logistic regression. Results: 409 biopsies with ADH on core biopsy, with later surgical excision, were included. The overall upgrade rate was (16.1%, 95% CI:12.9-20.0%); 10 patients had invasive cancer at excision and 56 DCIS only. Features on core biopsy most strongly associated with upgrade were imaging estimated percent of lesion removed (upgrade 9% for 90% removed, 14% for 50 to 75%, and 27% for < 50% removed), individual cell necrosis (upgrade 34% with necrosis vs. 9.5% without), and # foci of ADH (22% for >1 focus vs 8% for 1 focus). A multivariate predictive model (see Table) showed an average C-statistic of 0.77. Women with no necrosis and either 1 focus with ≥ 50% removal or >1 focus with 90% removal (36% of the sample) have low risk of upgrade (5.0%, 95% CI:1.3-8.7%). Conclusions: ADH on core biopsy with low risk of upgrade to cancer is defined by percent of imaging lesion removed, # of foci of ADH, and lack of individual cell necrosis. If findings are validated, women whose biopsies meet low-risk criteria might be considered for chemoprevention and surveillance rather than surgical excision.[Table: see text]

scholarly journals Atypical Ductal Hyperplasia of the Breast on Core Needle Biopsy - Risk of Malignant Upgrade on Surgical Excision.

2021 ◽  
Author(s):  
Tiffany Sin Hui Bong ◽  
Thaddaeus Tan ◽  
Juliana TS Ho ◽  
Puay Hoon Tan ◽  
Wing Sze Lau ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Surgical Excision ◽  
Hazard Ratio ◽  
Low Risk ◽  
Good Discrimination ◽  
Core Needle ◽  
Ductal Hyperplasia

Abstract Purpose: Atypical ductal hyperplasia (ADH) is a high risk lesion with an increased risk of developing breast cancer. This study aims to identify factors predictive of malignant upgrade for ADH diagnosed on core needle biopsy (CNB) and to develop a nomogram to facilitate evidence-based decision making.Methods: Retrospective analysis of women with CNB diagnosed ADH at the National Cancer Centre Singapore between 2010 and 2015 was performed. Cox proportional hazards regression was used to identify independent clinical, radiological and histological factors associated with malignant upgrade. A nomogram was constructed and multivariable logistic regression coefficients were used to estimate the predicted probability of upgrade for each factor combination. Combinations with the lowest predicted probabilities (≤5%) were identified as low risk. Model sensitivity, specificity, positive and negative predictive values were assessed.Results: From 2010-2015, 238,122 women underwent screening under the national breast cancer screening programme. 29,564 women were recalled and 5742 CNBs were performed, of which 2686 were performed at NCCS. 88 patients (90 lesions) were diagnosed with ADH. 26 lesions were upgraded to a breast malignancy on excision biopsy. On univariate analysis, presence of a mass on either ultrasound (p= 0.018) or mammogram (p=0.026), presence of mammographic microcalcifications (p=0.047), diffuse microcalcification distribution (p=0.034), mammographic parenchymal density (p=0.008), presence of microcalcifications on biopsy (p=0.037) and three or more separate foci of ADH found on biopsy (p=0.024) were associated with malignant upgrade. Mammographic parenchymal density (Hazard ratio= 0.04, 95% CI 0.005-0.35, p=0.014), presence of a mass on ultrasound (Hazard ratio= 10.50, 95% CI 9.21-25.2, p=0.010) and number of foci of ADH (Hazard ratio = 1.877, 95% CI 1.831-1.920, p=0.002) remained significant on multivariate analysis and were included in the normogram which demonstrated good discrimination with C-statistic of 0.81 [95% CI, 0.74 to 0.88].Conclusion: Our model provides good discrimination of breast cancer risk prediction in patients with ADH on CNB. A subset of women at low risk (<5%) of upgrade to cancer may avoid surgical excision following a core-needle biopsy diagnosis of ADH.

Identifying Patients with Atypical Ductal Hyperplasia Diagnosed at Core-Needle Biopsy Who Are at Low Risk of Malignancy

Radiology ◽  
2010 ◽  
Vol 257 (3) ◽  
pp. 893-894 ◽  
Author(s):  
Constance T. Albarracin ◽  
Christopher V. Nguyen ◽  
Gary J. Whitman ◽  
Wei Weiang ◽  
Nour Sneige
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Low Risk ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Risk Of Malignancy

Predictors of Underestimation of Malignancy after Image-Guided Core Needle Biopsy Diagnosis of Flat Epithelial Atypia or Atypical Ductal Hyperplasia

2015 ◽  
Vol 21 (3) ◽  
pp. 224-232 ◽  
Author(s):  
Chi-Chang Yu ◽  
Shir-Hwa Ueng ◽  
Yun-Chung Cheung ◽  
Shih-Che Shen ◽  
Wen-Lin Kuo ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Flat Epithelial Atypia ◽  
Core Needle ◽  
Image Guided ◽  
Biopsy Diagnosis ◽  
Ductal Hyperplasia ◽  
Epithelial Atypia

Is bigger better? Twenty-year institutional experience of atypical ductal hyperplasia discovered by core needle biopsy

2019 ◽  
Vol 217 (5) ◽  
pp. 906-909 ◽  
Author(s):  
Jessica B. Weiss ◽  
Woo S. Do ◽  
Dominic M. Forte ◽  
Rowan R. Sheldon ◽  
Charles K. Childers ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Institutional Experience

Atypical ductal hyperplasia on core needle biopsy: Surgical outcomes of 200 consecutive cases from a high‐volume breast program

2021 ◽  
Author(s):  
Pawel Karwowski ◽  
Dean Lumley ◽  
Deidre Stokes ◽  
Matthew Pavlica ◽  
Bonnie Edsall ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Surgical Outcomes ◽  
Needle Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
High Volume ◽  
Core Needle ◽  
Ductal Hyperplasia

Atypical Ductal Hyperplasia Diagnosed at Sonographically Guided Core Needle Biopsy: Frequency, Final Surgical Outcome, and Factors Associated With Underestimation

2014 ◽  
Vol 202 (6) ◽  
pp. 1389-1394 ◽  
Author(s):  
Benoît Mesurolle ◽  
Juan Carlos Hidalgo Perez ◽  
Fahad Azzumea ◽  
Emmanuelle Lemercier ◽  
Xuanqian Xie ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Surgical Outcome ◽  
Needle Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Core Needle ◽  
Factors Associated ◽  
Ductal Hyperplasia

scholarly journals Underestimation of cancer in case of diagnosis of atypical ductal hyperplasia (ADH) by vacuum assisted core needle biopsy

2012 ◽  
Vol 17 (3) ◽  
pp. 129-133 ◽  
Author(s):  
Karol Polom ◽  
Dawid Murawa ◽  
Paweł Kurzawa ◽  
Michał Michalak ◽  
Paweł Murawa
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Core Needle ◽  
Ductal Hyperplasia
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