Atypical ductal hyperplasia on vacuum-assisted breast biopsy: suspicion for ductal carcinoma in situ can stratify patients at high risk for upgrade☆

Abstract Objectives Women with atypical ductal hyperplasia (ADH), unlike those with ductal carcinoma in situ (DCIS), are denied eligibility for active surveillance clinical trials. Methods We applied the inclusion criteria of the Comparison of Operative to Monitoring and Endocrine Therapy (COMET) trial to the cases of women (n = 165) at the Roswell Park Cancer Institute who had a diagnosis of ADH, ADH bordering on DCIS, or low- to intermediate-grade DCIS on core biopsy taken during screening mammography. Upgrade of lesions to high risk was based on invasive carcinoma, high-grade DCIS, or DCIS with comedo necrosis. Results In total, nine (5.5%) lesions were upgraded: two (1.7%) reported ADH, one (5.9%) reported ADH bordering on DCIS, and six (19.4%) reported DCIS (P = .002); and two (1.6%) reclassified ADH vs seven (17.1%) reclassified DCIS (P < .001). In multivariate analysis, only increased number of foci had the potential to predict high risk (odds ratio: 1.39; P = .06). Conclusions We conclude that ADH and ADH bordering on DCIS have lower upgrade rates than DCIS. We recommend opening an active surveillance clinical trial for women with these diagnoses.

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Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted biopsy.

Radiology ◽

10.1148/radiology.202.3.9051043 ◽

1997 ◽

Vol 202 (3) ◽

pp. 843-847 ◽

Cited By ~ 248

Author(s):

F Burbank

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Ductal Hyperplasia ◽

Stereotactic Breast Biopsy ◽

Improved Accuracy

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Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution

Radiologia Brasileira ◽

10.1590/0100-3984.2014.0110 ◽

2016 ◽

Vol 49 (1) ◽

pp. 6-11 ◽

Cited By ~ 9

Author(s):

Gustavo Machado Badan ◽

Decio Roveda Júnior ◽

Sebastião Piato ◽

Eduardo de Faria Castro Fleury ◽

Mário Sérgio Dantas Campos ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Surgical Excision ◽

Target Lesion ◽

Core Needle ◽

Ductal Hyperplasia ◽

Underestimation Rate

Abstract Objective: To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary objective, the frequency of ADH and DCIS was determined for the cases submitted to biopsy. Materials and Methods: Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis of biopsies performed between February 2011 and July 2013, subsequently submitted to surgery, whose histopathological reports were available in the internal information system. Biopsy results were compared with those observed at surgery and the underestimation rate was calculated by means of specific mathematical equations. Results: The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at VABB it was 25% for ADH and 14.28% for DCIS. ADH represented 10.25% of all cases undergoing biopsy, whereas DCIS accounted for 23.91%. Conclusion: The diagnostic underestimation rate at CNB is two times the rate at VABB. Certainty that the target has been achieved is not the sole determining factor for a reliable diagnosis. Removal of more than 50% of the target lesion should further reduce the risk of underestimation.

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Ductal Carcinoma In Situ and Atypical Ductal Hyperplasia of the Breast Diagnosed at Stereotactic Core Biopsy

The Breast Journal ◽

10.1046/j.1524-4741.2001.007001014.x ◽

2001 ◽

Vol 7 (1) ◽

pp. 14-18 ◽

Cited By ~ 19

Author(s):

I. Mendez ◽

F. J. Andreu ◽

E. Saez ◽

M. Sentis ◽

I. Jurado ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Core Biopsy ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Stereotactic Core Biopsy ◽

Ductal Hyperplasia ◽

Stereotactic Core

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Diagnosis of Papillary Breast Lesions on Core Needle Biopsy: Upgrade Rates and Interobserver Variability

International Journal of Surgical Pathology ◽

10.1177/1066896919854543 ◽

2019 ◽

Vol 27 (7) ◽

pp. 736-743 ◽

Cited By ~ 1

Author(s):

Lianqun Qiu ◽

Daniel D. Mais ◽

Marlo Nicolas ◽

Jennifer Nanyes ◽

Kenneth Kist ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Imaging ◽

Interobserver Variability ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Breast Lesions ◽

Ductal Hyperplasia ◽

Papillary Lesions

The histologic distinction between papillary breast lesions remains challenging, especially with core biopsy (CB) specimens. A retrospective review of the clinical, imaging, and histologic findings was performed for patients with papillary breast lesions on CB from 2013 to 2017. The interpretation accuracy was expressed as upgrade rate relative to the excision diagnosis. Diagnostic reproducibility with and without immunohistochemistry was analyzed as interobserver variability among 3 board-certified pathologists. Among 57 papillary lesions with biopsies and excisions available for review, the upgrade rates were 0% for benign papilloma, 30% for papilloma with atypical ductal hyperplasia, and 25% for papilloma with ductal carcinoma in situ, resulting in an overall upgrade rate of 11.1%. There were no statistical differences between patients in an upgrade group and others, when comparing the patient age, clinical presentation, BI-RADS (Breast Imaging Reporting and Database System) category, location, and histologic grade. The overall interobserver variability of the 60 consecutive core biopsies of papillary breast lesions by morphology alone was in the “substantial” agreement range (κ = 0.79, 86% agreement), with an excellent κ score of 0.88 for papilloma (92% agreement). “Substantial” and “fair” κ values were seen for papilloma with atypical ductal hyperplasia/ductal carcinoma in situ (0.74, 84% agreement) and invasive carcinoma (0.40, 60% agreement). Use of immunohistochemical stains improved the κ values into “excellent” range (0.92, 94% agreement). Our study favors a conservative approach in the management of benign papillomas, at least in cases of good radiologic-pathologic concordance. Papillary breast lesions with atypia/malignancy show lower diagnostic reproducibility on CB, and utility of immunohistochemistry is recommended in challenging cases.

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Prospective Analysis Using a Novel CNN Algorithm to Distinguish Atypical Ductal Hyperplasia From Ductal Carcinoma in Situ in Breast

Clinical Breast Cancer ◽

10.1016/j.clbc.2020.06.001 ◽

2020 ◽

Vol 20 (6) ◽

pp. e757-e760

Author(s):

Simukayi Mutasa ◽

Peter Chang ◽

John Nemer ◽

Eduardo Pascual Van Sant ◽

Mary Sun ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Prospective Analysis ◽

Ductal Hyperplasia

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Atypical ductal hyperplasia and ductal carcinoma in situ of the breast associated with perineural invasion

Human Pathology ◽

10.1053/hupa.2001.27637 ◽

2001 ◽

Vol 32 (8) ◽

pp. 785-790 ◽

Cited By ~ 15

Author(s):

Helenice Gobbi ◽

Roy A. Jensen ◽

Jean F. Simpson ◽

Sandra J. Olson ◽

David L. Page

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Perineural Invasion ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Ductal Hyperplasia

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Differences and Relationships Between Normal and Atypical Ductal Hyperplasia, Ductal Carcinoma In Situ, and Invasive Ductal Carcinoma Tissues in the Breast Based on Raman Spectroscopy

Applied Spectroscopy ◽

10.1177/0003702816681009 ◽

2016 ◽

Vol 71 (2) ◽

pp. 300-307 ◽

Cited By ~ 6

Author(s):

Bing Han ◽

Ye Du ◽

Ton Fu ◽

Zhimin Fan ◽

Shuping Xu ◽

...

Keyword(s):

Raman Spectroscopy ◽

Invasive Ductal Carcinoma ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Normal Tissue ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Normal Tissues ◽

Ductal Hyperplasia

The aim of this study was to find the differences and relationships between normal, atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS), and invasive ductal carcinoma (IDC) lesions of the breast based on biochemical characteristics determined by Raman spectroscopy (RS). After collecting 39 frozen sections from patients who underwent surgical resection or mammotome biopsy, nine normal tissues, seven ADH, eight DCIS, and 15 IDC lesions were detected using confocal RS. We then used leave-one-out cross-validation (LOOCV) and radial basis function (RBF) to build a support vector machine (SVM) diagnosis model. Pronounced mean Raman spectra differences were observed between normal tissues, ADH, DCIS, and IDC tissues. Most noticeable was the increased protein and reduced lipid levels of ADH tissues compared to normal tissues. The major spectra differences in ADH, DCIS, and IDC spectrograms were evidenced by a red shift with a broad peak of CH2 (1301 cm−1), the intensity of the stretching vibration peak of carotenoids (1526 cm−1), a relatively strong band of amide-I (1656 cm−1), and the nuclear (882 cm−1) acid peak. Atypical ductal hyperplasia tissues had the largest constituent variations between subjects. During the disease progression, IDC tissues have smaller inter-subject constituent variations than DCIS and ADH tissues. The overall accuracy of SVM model is 74.39%. The sensitivities of normal tissue, ADH, DCIS, and IDC are 62.5%, 50%, 90%, and 66.7%, respectively. The specificities of normal tissue, ADH, DCIS, and IDC are 100%, 100%, 66.7%, and 89.06%, respectively. Atypical ductal hyperplasia shows significant differences and the relationship between normal tissue and malignant disease. Further study to explain the biochemical relationships between these differences will shed more light into a better understanding of the mechanism by which ADH converts to DCIS and to IDC.

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