Thaer Khoury1, Zaibo Li2, Souzan Sanati3, Mohamed M Desouki4, Xiwei Chen5, Dan Wang5, Song Liu5, Rouzan Karabakhtsian6, Prasanna Kumar7, Beatriu Reig8. 1. Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA. 2. Department of Pathology, Ohio State University, Columbus, OH, USA. 3. Department of Pathology, Washington University, St Louis, MO, USA. 4. Department of Pathology, Vanderbilt University, Nashville, TN, USA. 5. Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA. 6. Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. 7. Department of Radiology, Roswell Park Cancer Institute, Buffalo, NY, USA. 8. Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Abstract
AIMS: To identify variables that can predict upgrade for magnetic resonance imaging (MRI)-detected atypical ductal hyperplasia (ADH). METHODS AND RESULTS: We reviewed 1655 MRI-guided core biopsies between 2005 and 2013, yielding 100 (6%) cases with ADH. The pathological features of ADH and MRI findings were recorded. An upgrade was considered when the subsequent surgical excision yielded invasive carcinoma (IC) or ductal carcinoma in situ (DCIS). The rate of ADH between institutions was 3.3-7.1%, with an average of 6%. A total of 15 (15%) cases had upgrade, 12 DCIS and three IC. When all cases were included, only increased number of involved cores was statistically significant (P = 0.02). When cases with concurrent lobular neoplasia (LN) were excluded (n = 14), increased number of ADH foci and increased number of involved cores were statistically significant (P = 0.002, P = 0.009). We analysed the data separately from a single institution (n = 61). Increased number of foci, increased number of total cores and involved cores and larger ADH size predicted upgrade with statistical significance. CONCLUSIONS: The incidence of ADH in MRI-guided core biopsy is rare. The rate of upgrade is comparable to mammographically detected ADH, warranting surgical excision. Similar to mammographically detected lesions, the volume of the ADH predicts the upgrade.
AIMS: To identify variables that can predict upgrade for magnetic resonance imaging (MRI)-detected atypical ductal hyperplasia (ADH). METHODS AND RESULTS: We reviewed 1655 MRI-guided core biopsies between 2005 and 2013, yielding 100 (6%) cases with ADH. The pathological features of ADH and MRI findings were recorded. An upgrade was considered when the subsequent surgical excision yielded invasive carcinoma (IC) or ductal carcinoma in situ (DCIS). The rate of ADH between institutions was 3.3-7.1%, with an average of 6%. A total of 15 (15%) cases had upgrade, 12 DCIS and three IC. When all cases were included, only increased number of involved cores was statistically significant (P = 0.02). When cases with concurrent lobular neoplasia (LN) were excluded (n = 14), increased number of ADH foci and increased number of involved cores were statistically significant (P = 0.002, P = 0.009). We analysed the data separately from a single institution (n = 61). Increased number of foci, increased number of total cores and involved cores and larger ADH size predicted upgrade with statistical significance. CONCLUSIONS: The incidence of ADH in MRI-guided core biopsy is rare. The rate of upgrade is comparable to mammographically detected ADH, warranting surgical excision. Similar to mammographically detected lesions, the volume of the ADH predicts the upgrade.
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