Vacuum-assisted biopsy diagnosis of atypical ductal hyperplasia and patient management

Ancona, Antonietta; Capodieci, M.; Galiano, Alessandro; Mangieri, Fabio; Lorusso, Vito; Gatta, Gianluca

doi:10.1007/s11547-011-0626-9

Cited by 23 publications

(21 citation statements)

References 29 publications

(49 reference statements)

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“…In studies analyzing patients on surveillance without surgical treatment following a VAB diagnosis of ADH, long-term upgrade rates to invasive breast cancer of 3–8 % are reported [19, 26]. 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].…”

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%

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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

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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.

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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

“…From these analyses, it is quite acceptable that no significant difference of underestimation was observed between two groups, considering that microcalcification is a risk factor of underestimation. The use of the 11-gauge vacuum-assisted device or excision has also become more popular for benign breast lesions especially in younger women [7,8,10]. But since there is not enough data to confirm the significant benefit of vacuum-assisted device excision in terms of underestimation, patient selection should be done with caution considering major issues such as whether adequate margin evaluation is possible, and that later surgery may be difficult due to the associated tissue destruction [11].…”

Section: Discussionmentioning

confidence: 99%

“…The reported rate of underestimation of carcinoma in CNB-diagnosed ADH is as high as 48% [3-8]. Therefore, complete surgical excision is generally recommended for ADH lesions diagnosed using CNB.…”

Section: Introductionmentioning

confidence: 99%

Validation of a Scoring System for Predicting Malignancy in Patients Diagnosed with Atypical Ductal Hyperplasia Using an Ultrasound-Guided Core Needle Biopsy

Kim

Han

et al. 2012

J Breast Cancer

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PurposeThe need for surgical excision in patients with ultrasound-guided core needle biopsy (CNB)-diagnosed atypical ductal hyperplasia (ADH) remains an issue of debate. The present study sought to validate a scoring system (the U score, for underestimation) that we have previously developed for predicting malignancy in CNB-diagnosed ADH.MethodsThe study prospectively enrolled 85 female patients with CNB-diagnosed ADH who underwent subsequent surgical excision. Underestimation was defined as a surgical specimen having malignant foci.ResultsThe overall underestimation rate was 37% (31/85). Multivariate analysis showed that a clinically palpable mass, microcalcification on imaging, size >15 mm and a patient age of ≥50 years were independently associated with underestimation. When applied to the scoring system, the validation score was significant (p<0.001; area under the curve, 0.852). No patient with a U score <3.5 had an underestimated lesion.ConclusionThe present study successfully validated the efficacy of our scoring system for predicting malignancy in CNB-diagnosed ADH. A U score of ≤3.5 indicates that surgical excision may not be necessary.

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“…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.…”

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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

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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...

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Vacuum-assisted biopsy diagnosis of atypical ductal hyperplasia and patient management

Cited by 23 publications

References 29 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)

Validation of a Scoring System for Predicting Malignancy in Patients Diagnosed with Atypical Ductal Hyperplasia Using an Ultrasound-Guided Core Needle Biopsy

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

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