Michael Co1, Ava Kwong2, Tony Shek3. 1. Department of Surgery, The University of Hong Kong, Hong Kong. 2. Department of Surgery, The University of Hong Kong, Hong Kong. Electronic address: avakwong@hku.hk. 3. Department of Pathology, Queen Mary Hospital, Hong Kong.
Abstract
INTRODUCTION: Due to the possibility of underestimation, surgical excision is usually offered to patients with atypical ductal hyperplasia (ADH) diagnosed with core needle biopsy (CNB). Here we review the 10-year data of patients with ADH diagnosed by CNB, aiming to identify the factors associated with under-diagnosis. METHODS: Retrospective review of database from 1st Jan 2005 to 31st Dec 2014 was performed; patients with ADH diagnosed by CNB were identified. Diagnosis upgrade rate and its risk factors were evaluated. RESULTS: 104 patients were found to have ADH on CNB, 101 patients received excisional biopsy while 3 patients refused operation. 34 patients had ductal carcinoma in situ (DCIS) after excision, 6 had invasive ductal carcinoma, 1 had lobular carcinoma in situ and 1 had angiosarcoma. CNB under-diagnosed up to 41.6% of malignant lesions. Breast mass on presentation and suspicious mammograms (BIRADS ≥ 4) are associated with diagnosis upgrade (P = 0.0005, 0.0001). Literature review of 39 studies between 1997 and 2017 revealed 3125 excision procedures performed for ADH diagnosed by CNB, the pooled median diagnosis upgrade rate was 25% (Range 4-54%). CONCLUSION: We recommend excision in all patients with ADH diagnosed by CNB, especially in patients with suspicious mammographic features.
INTRODUCTION: Due to the possibility of underestimation, surgical excision is usually offered to patients with atypical ductal hyperplasia (ADH) diagnosed with core needle biopsy (CNB). Here we review the 10-year data of patients with ADH diagnosed by CNB, aiming to identify the factors associated with under-diagnosis. METHODS: Retrospective review of database from 1st Jan 2005 to 31st Dec 2014 was performed; patients with ADH diagnosed by CNB were identified. Diagnosis upgrade rate and its risk factors were evaluated. RESULTS: 104 patients were found to have ADH on CNB, 101 patients received excisional biopsy while 3 patients refused operation. 34 patients had ductal carcinoma in situ (DCIS) after excision, 6 had invasive ductal carcinoma, 1 had lobular carcinoma in situ and 1 had angiosarcoma. CNB under-diagnosed up to 41.6% of malignant lesions. Breast mass on presentation and suspicious mammograms (BIRADS ≥ 4) are associated with diagnosis upgrade (P = 0.0005, 0.0001). Literature review of 39 studies between 1997 and 2017 revealed 3125 excision procedures performed for ADH diagnosed by CNB, the pooled median diagnosis upgrade rate was 25% (Range 4-54%). CONCLUSION: We recommend excision in all patients with ADH diagnosed by CNB, especially in patients with suspicious mammographic features.
Authors: Kate R Pawloski; Nicole Christian; Andrea Knezevic; Hannah Y Wen; Kimberly J Van Zee; Monica Morrow; Audree B Tadros Journal: Breast Cancer Res Treat Date: 2020-08-28 Impact factor: 4.872
Authors: Christoph J Rageth; Elizabeth A M O'Flynn; Katja Pinker; Rahel A Kubik-Huch; Alexander Mundinger; Thomas Decker; Christoph Tausch; Florian Dammann; Pascal A Baltzer; Eva Maria Fallenberg; Maria P Foschini; Sophie Dellas; Michael Knauer; Caroline Malhaire; Martin Sonnenschein; Andreas Boos; Elisabeth Morris; Zsuzsanna Varga Journal: Breast Cancer Res Treat Date: 2018-11-30 Impact factor: 4.872
Authors: Christoph J Rageth; Ravit Rubenov; Cristian Bronz; Daniel Dietrich; Christoph Tausch; Ann-Katrin Rodewald; Zsuzsanna Varga Journal: Breast Cancer Date: 2018-12-27 Impact factor: 4.239