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.

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

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

scholarly journals Development and Validation of a Simple-to-Use Nomogram for Predicting the Upgrade of Atypical Ductal Hyperplasia on Core Needle Biopsy in Ultrasound-Detected Breast Lesions

2021 ◽  
Vol 10 ◽  
Author(s):  
Yun-Xia Huang ◽  
Ya-Ling Chen ◽  
Shi-Ping Li ◽  
Ju-Ping Shen ◽  
Ke Zuo ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Surgical Excision ◽  
Training Set ◽  
Good Discrimination ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Malignant Lesions ◽  
Validation Set

BackgroundThe rate of carcinoma upgrade for atypical ductal hyperplasia (ADH) diagnosed on core needle biopsy (CNB) is variable on open excision. The purpose of the present study was to develop and validate a simple-to-use nomogram for predicting the upgrade of ADH diagnosed with ultrasound (US)-guided core needle biopsy in patients with US-detected breast lesions.MethodsTwo retrospective sets, the training set (n = 401) and the validation set (n = 186), from Fudan University Shanghai Cancer Center between January 2014 and December 2019 were retrospectively analyzed. Clinicopathological and US features were selected using univariate and multivariable logistic regression, and the significant features were incorporated to build a nomogram model. Model discrimination and calibration were assessed in the training set and validation set.ResultsOf the 587 ADH biopsies, 67.7% (training set: 267/401, 66.6%; validation set: 128/186, 68.8%) were upgraded to cancers. In the multivariable analysis, the risk factors were age [odds ratio (OR) 2.739, 95% confidence interval (CI): 1.525–5.672], mass palpation (OR 3.008, 95% CI: 1.624–5.672), calcifications on US (OR 4.752, 95% CI: 2.569–9.276), ADH extent (OR 3.150, 95% CI: 1.951–5.155), and suspected malignancy (OR 4.162, CI: 2.289–7.980). The model showed good discrimination, with an area under curve (AUC) of 0.783 (95% CI: 0.736–0.831), and good calibration (p = 0.543). The application of the nomogram in the validation set still had good discrimination (AUC = 0.753, 95% CI: 0.666–0.841) and calibration (p = 0.565). Instead of surgical excision of all ADHs, if those categorized with the model to be at low risk for upgrade were surveillanced and the remainder were excised, then 63.7% (37/58) of surgeries of benign lesions could have been avoided and 78.1% (100/128) malignant lesions could be treated in time.ConclusionsThis study developed a simple-to-use nomogram by incorporating clinicopathological and US features with the overarching goal of predicting the probability of upgrade in women with ADH. The nomogram could be expected to decrease unnecessary surgery by nearly two-third and to identify most of the malignant lesions, helping guide clinical decision making with regard to surveillance versus surgical excision of ADH lesions.

scholarly journals Prediction of Atypical Ductal Hyperplasia Upgrades Through a Machine Learning Approach to Reduce Unnecessary Surgical Excisions

2018 ◽  
pp. 1-11 ◽  
Author(s):  
Lia Harrington ◽  
Roberta diFlorio-Alexander ◽  
Katherine Trinh ◽  
Todd MacKenzie ◽  
Arief Suriawinata ◽  
...  
Keyword(s):  
Machine Learning ◽  
Random Forest ◽  
Needle Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Surgical Excision ◽  
Gradient Boosting ◽  
Benign Lesions ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Machine Learning Models

Purpose Surgical excision is currently recommended for all occurrences of atypical ductal hyperplasia (ADH) found on core needle biopsies for malignancy diagnoses and treatment of lesions. The excision of all ADH lesions may lead to overtreatment, which results in invasive surgeries for benign lesions in many women. A machine learning method to predict ADH upgrade may help clinicians and patients decide whether combined active surveillance and hormonal therapy is a reasonable alternative to surgical excision. Methods The following six machine learning models were developed to predict ADH upgrade from core needle biopsy: gradient-boosting trees, random forest, radial support vector machine (SVM), weighted K-nearest neighbors (KNN), logistic elastic net, and logistic regression. The study cohort consisted of 128 lesions from 124 women at a tertiary academic care center in New Hampshire who had ADH on core needle biopsy and who underwent an associated surgical excision from 2011 to 2017. Results The best-performing models were gradient-boosting trees (area under the curve [AUC], 68%; accuracy, 78%) and random forest (AUC, 67%; accuracy, 77%). The top five most important features that determined ADH upgrade were age at biopsy, lesion size, number of biopsies, needle gauge, and personal and family history of breast cancer. Using the random forest model, 98% of all malignancies would have been diagnosed through surgical biopsies, whereas 16% of unnecessary surgeries on benign lesions could have been avoided (ie, 87% sensitivity at 45% specificity). Conclusion These results add to the growing body of support for machine learning models as useful aids for clinicians and patients in decisions about the clinical management of ADH.

Is Excisional Biopsy Needed for Pure FEA Diagnosed on a Core Biopsy?

2020 ◽  
Vol 86 (9) ◽  
pp. 1088-1090
Author(s):  
Jennifer L. Miller-Ocuin ◽  
Brett B. Fowler ◽  
Daniel L. Coldren ◽  
Akiko Chiba ◽  
Edward A. Levine ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Core Biopsy ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Invasive Cancer ◽  
Architectural Distortion ◽  
Core Needle ◽  
Ductal Hyperplasia

Background The management of flat epithelial atypia (FEA) on core needle biopsy remains controversial. The upstaging rates after surgical excision are variable. In this study, we seek to determine the upstaging rate of FEA at our institution. Methods Patients with a diagnosis of FEA were identified from the institution’s pathology database from 2009 to 2018. Patients were included in the study if FEA alone, without atypia or cancer, was identified on core needle biopsy. Patient demographics, imaging, management, and pathology characteristics were obtained. Statistical analysis performed using IBM SPSS 26.0 (Armonk, NY, USA). Results FEA was diagnosed on core needle biopsy in 235 patients from 2009 to December 2018. Forty-eight patients met the inclusion criteria. The majority of patients presented with calcifications on mammogram (n = 21, 64%) with the remainder as masses (n = 6, 18%) or architectural distortion (n = 6, 18%). Of those, 15 (31%) patients declined surgical excision, of which none developed cancer over a mean follow-up of 4.4 years. Of the 33 (69%) patients undergoing excisional biopsy, 17 (52%) confirmed FEA, 11 (33%) had benign findings, and 3 (9%) demonstrated atypical ductal hyperplasia on final pathology. One (3%) case revealed ductal carcinoma in situ (DCIS) and 1 (3%) was upgraded to invasive cancer for an overall upstaging rate of 4% (2/48). After a mean follow-up of 3.4 years, none of the excisional biopsy patients developed invasive breast cancer. Adjuvant therapy was used in the cases of DCIS and invasive cancer; however, chemoprevention with raloxifene or tamoxifen was not chosen by any of the remaining patients. Conclusion In our cohort, expectant management of FEA alone appears to be a safe option as our upstaging rate to DCIS or invasive cancer for FEA diagnosed on core biopsy was only 4%. Our study suggests that close follow-up is a safe and feasible option for pure FEA without a radiographic discordance found on core biopsy.

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

scholarly journals 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

2016 ◽  
Vol 49 (1) ◽  
pp. 6-11 ◽  
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.

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
Sign in / Sign up

Export Citation Format

Share Document