Factors that impact the upgrading of atypical ductal hyperplasia

Gümüş, Hatice; Mills, P.; Gümüş, Metehan; Fish, David E.; Jones, Sue; Jones, Peter A.; Devalia, Haresh; Sever, Ali

doi:10.4261/1305-3825.dir.5838-12.2

Cited by 9 publications

(17 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even with complete removal of malignant microcalcifications by VAB, underestimation rates up to 17 % are documented [26–29]. The highest underestimation rates (22–65 %) are published for ultrasound-guided 14G CNB [21, 22, 25, 30–34] while ultrasound-guided VABs have much lower rates of underestimation (0–22 %) [33, 35]. Grady et al found no underestimation in lesions completely removed by 8 G ultrasound-guided VAB [35].…”

Section: Resultsmentioning

confidence: 99%

“…After therapeutic surgical excision of ADH, patients had a fourfold increased risk of developing breast cancer in either breast with a cumulative incidence of 30 % in 25 years [10, 11, 38, 39]. Currently, there is very little data to indicate that lesions smaller than 6 mm completely excised by VAB with less than 2 foci of ADH may safely avoid surgery [14, 19, 21, 26, 40]. …”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Rageth

O’Flynn

Comstock

et al. 2016

Breast Cancer Res Treat

189

149

View full text Add to dashboard Cite

The purpose of this study is to obtain a consensus for the therapy of B3 lesions. The first International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) including atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumors (PT), and radial scars (RS) took place in January 2016 in Zurich, Switzerland organized by the International Breast Ultrasound School and the Swiss Minimally Invasive Breast Biopsy group—a subgroup of the Swiss Society of Senology. Consensus recommendations for the management and follow-up surveillance of these B3 lesions were developed and areas of research priorities were identified. The consensus recommendation for FEA, LN, PL, and RS diagnosed on core needle biopsy or vacuum-assisted biopsy (VAB) is to therapeutically excise the lesion seen on imaging by VAB and no longer by open surgery, with follow-up surveillance imaging for 5 years. The consensus recommendation for ADH and PT is, with some exceptions, therapeutic first-line open surgical excision. Minimally invasive management of selected B3 lesions with therapeutic VAB is acceptable as an alternative to first-line surgical excision.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Rageth

O’Flynn

Comstock

et al. 2016

Breast Cancer Res Treat

189

149

View full text Add to dashboard Cite

show abstract

“…The setting for this audit is BreastScreen South Australia. BreastScreen South Australia is part of a national breast cancer screening program, aimed at 12 50 56% Gumus 6 105 41.7% (NCB), 20.6% (VAB) Polom 14 134 9% McGhan 11 114 18% Kim 10 85 37% Hsu 8 134 39.6% Bendifallah 4 107 19% Nguyen 13 140 11.4% Hong 7 124 45.2% Deshaies 5 422 31.3% Ancona 3 98 19.4% Allison 2 97 20.6% asymptomatic women 50-69. Recently, the age range has been extended to women aged 74.…”

Section: The Design Of Our Breast Cancer Screening Programmentioning

confidence: 99%

“…Even in contemporary practice, reflected in studies published since 2011 (Table 1), the upgrade rates for atypical ductal hyperplasia diagnosed on core biopsy range from 9-56%. [2][3][4][5][6][7][8][9][10][11][12][13][14] To our knowledge, at present four randomized clinical trials of active surveillance for so called 'low-risk ductal carcinoma in situ' are at various stages of activation. These include the UK LORIS trial, 15 LORD (ClinicalTrials.gov Identifier: NCT02492607), 16 COMET (ClinicalTrials.gov Identifier: NCT02926911), and the Australian LARRAKIN trial.…”

mentioning

confidence: 99%

Active surveillance of women diagnosed with atypical ductal hyperplasia on core needle biopsy may spare many women potentially unnecessary surgery, but at the risk of undertreatment for a minority: 10-year surgical outcomes of 114 consecutive cases from a single center

et al. 2018

View full text Add to dashboard Cite

A needle core biopsy diagnosis of atypical ductal hyperplasia is an indication for open biopsy. The launch of randomized clinical trials of active surveillance for low-risk ductal carcinoma in situ leads to the paradoxical situation of women with low-grade ductal carcinoma in situ being observed, whereas those with atypical ductal hyperplasia have surgery. If the malignancies diagnosed after surgery for atypical ductal hyperplasia are dominated by low-risk ductal carcinoma in situ, women with atypical ductal hyperplasia may also be considered for surveillance. This 10-year prospective observational study includes women diagnosed with atypical ductal hyperplasia on core biopsy after screening mammography. We retrieved their clinical, imaging and histologic data and carried out a blind review of core biopsy histology, sub-classifying the atypical ductal hyperplasia along a spectrum from hyperplasia to ductal carcinoma in situ. Using the final surgical pathology data, we calculated: (1) The proportion and grades of ductal carcinoma in situ and invasive cancers diagnosed at open biopsy. (2) The histologic extent of the malignancy at surgery. (3) The biomarker profile and nodal status of any invasive cancers. (4) Ascertained any independent predictors of (i) any malignancy, (ii) high-risk malignancy, defined in this study as invasive cancer, or high-grade ductal carcinoma in situ, or intermediate grade ductal carcinoma in situ with any necrosis. (5) Extrapolated the above to simulate active surveillance for women with screen-detected atypical ductal hyperplasia. Between January 2005 and December 2014, 114 women, mean age 59 years (range 40-79 years) were included. Surgical pathology, available in 110 (97%), confirmed malignancy in 46 (40%). All 46 malignant cases had ductal carcinoma in situ, accompanied by invasive carcinoma in 9 (8%) women. Together, 21 (19%) women had either invasive cancer (9%), high-grade ductal carcinoma in situ (6%), or necrotizing, intermediate grade ductal carcinoma in situ (6%). Only one of nine invasive breast cancers was grade 1, 3 were multifocal, all were ≤8 mm, node negative, and ER positive but two were HER2 amplified. The mean extent of the ductal carcinoma in situ in any one specimen was 19.8 mm, median 13 mm, range 2-110 mm. Overall 32 women, 29% of the whole cohort and 70% of those 46 with malignancy, required further surgery, including mastectomy in 12 (11%). A multivariable model for predicting the likelihood of any malignancy showed a statistically significant association only with the post review subtype of atypical ductal hyperplasia, adjusting for lesion size. Independent predictors of high-risk malignancy (invasive cancer or non-low-grade ductal carcinoma in situ) were not identified. If active surveillance is adopted for screen-detected atypical ductal hyperplasia diagnosed on core biopsy, 60% of women will avoid unnecessary surgery and a further 24% would meet eligibility criteria for ductal carcinoma in situ surveillance trials. However, 18% of women will have undiagnosed...

show abstract

“…The underestimation rates reported for FEA diagnosed on macrobiopsy (11G) varied from 0 to 20%: 0 (0/33 and 0/24) for Piubello et al [50] conducted a literature review: in 16 studies with 1929 cases of ADH [56], the underestimation rate varied from 13 to 21% in studies that exclusively or mostly included macrobiopsies (9-11 G) and 34 to 65% in studies with microbiopsy only (14 G) [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71].…”

Section: -Pure Fea On Percutaneous Breast Biopsy Villa Et Al Analysmentioning

confidence: 99%

Atypical epithelial hyperplasia of the breast: state of the art

Dion

Racin

Brousse

et al. 2016

Expert Review of Anticancer Therapy

View full text Add to dashboard Cite

A review of published studies was performed using medline database. In this review, we fully describe the current evidence available. In particular, we describe 1) data from immunohistochemistry and molecular studies that suggest AEH is a precursor of breast cancer; 2) epidemiological studies demonstrate low rate of breast cancer in women with AEH; 3) surgical excision is necessary after diagnosis of AEH, such as lobular carcinoma in situ or atypical ductal hyperplasia, on core needle biopsy; 4) although current recommendations are evolving to fewer (if not no) excisions for flat epithelial with atypia and classic lobular neoplasia found on percutaneous biopsy (without radiologic indications for excision). Expert commentary: HEA management steel need prospective evidences, but recent retrospective data give some clue for less invasive management for some of HEA.

show abstract

Factors that impact the upgrading of atypical ductal hyperplasia

Cited by 9 publications

References 27 publications

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

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

Active surveillance of women diagnosed with atypical ductal hyperplasia on core needle biopsy may spare many women potentially unnecessary surgery, but at the risk of undertreatment for a minority: 10-year surgical outcomes of 114 consecutive cases from a single center

Atypical epithelial hyperplasia of the breast: state of the art

Contact Info

Product

Resources

About