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

Karwowski, Pawel; Lumley, Dean; Stokes, Deidre; Pavlica, Matthew; Edsall, Bonnie; Fu, Sophia L.; Francfort, John W.; Cohen, Bradley; Capizzi, Anthony; Ma, Zhiwei; Green, Anne; Kao, Johnny

doi:10.1111/tbj.14170

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…Since the last consensus conference, several studies reported an upgrade rate of ADH into malignancy (DCIS or invasive cancer) between 7.3 and 57% in targeted OE. Consequently, the majority of these studies recommended OE, although increasingly considering other options such as imaging follow-up after VAB, when the calcifications in clinical imaging have been completely removed [6,19,[22][23][24][25][26][27][28][29][30][31]. In the MIBB database, patients with ADH underwent OE in the majority of cases (62.7%), and an upgrade rate of 25.2% was observed.…”

Section: Current Evidence For Underestimation After Cnb/vabmentioning

confidence: 99%

Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Elfgen,

Leo,

Kubik-Huch

et al. 2023

Virchows Arch

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The heterogeneous group of B3 lesions in the breast harbors lesions with different malignant potential and progression risk. As several studies about B3 lesions have been published since the last Consensus in 2018, the 3rd International Consensus Conference discussed the six most relevant B3 lesions (atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), radial scar (RS), papillary lesions (PL) without atypia, and phyllodes tumors (PT)) and made recommendations for diagnostic and therapeutic approaches. Following a presentation of current data of each B3 lesion, the international and interdisciplinary panel of 33 specialists and key opinion leaders voted on the recommendations for further management after core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). In case of B3 lesion diagnosis on CNB, OE was recommended in ADH and PT, whereas in the other B3 lesions, vacuum-assisted excision was considered an equivalent alternative to OE. In ADH, most panelists (76%) recommended an open excision (OE) after diagnosis on VAB, whereas observation after a complete VAB-removal on imaging was accepted by 34%. In LN, the majority of the panel (90%) preferred observation following complete VAB-removal. Results were similar in RS (82%), PL (100%), and FEA (100%). In benign PT, a slim majority (55%) also recommended an observation after a complete VAB-removal. VAB with subsequent active surveillance can replace an open surgical intervention for most B3 lesions (RS, FEA, PL, PT, and LN). Compared to previous recommendations, there is an increasing trend to a de-escalating strategy in classical LN. Due to the higher risk of upgrade into malignancy, OE remains the preferred approach after the diagnosis of ADH.

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Section: Current Evidence For Underestimation After Cnb/vabmentioning

confidence: 99%

Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Elfgen,

Leo,

Kubik-Huch

et al. 2023

Virchows Arch

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“…Although the management of these benign and atypical lesions is controversial, they are often excised to rule out underlying malignancy that is not detected during CNB [ 3 , 4 , 28 – 31 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of delay of excisional biopsy on upstage rate for atypical ductal hyperplasia, flat epithelial atypia, intraductal papilloma, and radial scar

Casaubon

Niakan

Vicks

et al. 2022

Breast Cancer Res Treat

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Purpose When Core Needle Biopsy (CNB) demonstrates Atypical Ductal Hyperplasia (ADH), Flat Epithelial Atypia (FEA), Intraductal Papilloma (IDP), or Radial Scar/Complex Sclerosing Lesion (RS), excisional biopsy (EB) is often performed to rule out underlying malignancy with upstage rates (UR) ranging between 1 and 20%. The COVID-19 pandemic led to delayed EB for many patients. We sought to evaluate whether this delay was associated with higher UR. Methods We performed a retrospective analysis of women who underwent CNB and then EB for ADH, FEA, IDP, or RS between 2017 and 2021 using an IRB-approved repository. UR was evaluated by days between CNB and EB. Results 473 patients met inclusion. 55 were upstaged to cancer (11.6%). 178 patients had pure ADH on CNB and 37 were upstaged (20.8%). 50 patients had pure FEA and 3 were upstaged (6%). 132 had pure IDP and 7 were upstaged (5.3%). 98 had pure RS and 1 was upstaged (1%). 7/15 (46.7%) had a combination of diagnoses or diagnosis with palpable mass and were upstaged. Days between CNB and EB were < 60 for 275 patients (58.1%), 60–90 for 108 (22.8%), 91–120 for 43 (9.1%), and > 120 for 47 (9.9%). There was no significant difference in UR (10.9% for < 60, 14.8% for 60–90, 7% for 90–120, and 12.8% for > 120, p = 0.54). UR for ADH was clinically increased after 60 days (27.8 vs. 17.5%), but this did not reach statistical significance ( p = 0.1). Conclusion Surgical delay was not associated with an increased UR.

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“…In Zusammenschau der Literaturdaten der letzten Jahre ist das Unterschätzungsrisiko bei einer ADH immer noch hoch und je nach Studie liegt die Upgraderate bei 10–50 % im nachfolgenden Exzisat [ 3 , 11 , 15 , 17 , 29 , 35 , 37 , 41 , 52 ]. Risikofaktoren sind dabei die fehlende Korrelation zwischen bildgebendem Befund und Pathologie, grössere/ausgedehntere bildgebende Befunde oder Herdbefunde und die Art der Biopsie (Diagnose der ADH an Stanz- oder Vakuumbiopsie) [ 4 , 34 , 38 , 41 ].…”

Section: Atypische Duktale Hyperplasieunclassified

B3-Läsionen der Mamma: Histologische, klinische und epidemiologische Aspekte

2023

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ZusammenfassungB3-Läsionen der Mamma stellen eine heterogene Gruppe von Läsionen mit unsicherem Malignitätspotenzial dar, welche histologisch klar definierte Diagnosen beinhalten und welche in diagnostischem und therapeutischem Kontext unterschiedlich gewichtet und behandelt werden. Vor allem die Entscheidung über die Schritte nach der Diagnose einer B3-Läsion an Stanzbiopsie oder Vakuumbiopsie können eine Herausforderung darstellen. B3-Läsionen werden oft wegen bildgebenden Kalzifikationen oder Herdbefunden entdeckt und biopsiert. Histologisch können die Veränderungen einer Reihe von häufigen Diagnosen (wie die atypische duktale Hyperplasie, die klassische lobuläre Neoplasie, flache Epithelatypien, intraduktale Papillome, radiäre Narben oder fibroepitheliale Tumoren vom Typ eines Phylloidestumors) oder seltenen Diagnosen (wie Mukozelen-ähnliche Läsion, atypische apokrine Läsionen und seltene stromale Proliferate) zugeordnet werden. Immunhistochemie ist hilfreich in der Differenzierung und einer korrekten nomenklatorischen Zuordnung dieser Läsionen (vor allem Östrogenrezeptoren, basale Zytokeratine, Myoepithelmarker oder stromale Markerpanel). Im klinischen Kontext bleibt die Korrelation der bildgebenden und histologischen Befunde der wichtigste Faktor in der Entscheidung der nächsten diagnostischen/therapeutischen Schritte.

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

Cited by 5 publications

References 10 publications

Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

The effect of delay of excisional biopsy on upstage rate for atypical ductal hyperplasia, flat epithelial atypia, intraductal papilloma, and radial scar

B3-Läsionen der Mamma: Histologische, klinische und epidemiologische Aspekte

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