Luca Nicosia1, Antuono Latronico1, Francesca Addante2, Rossella De Santis3, Anna Carla Bozzini1, Marta Montesano1, Samuele Frassoni4, Vincenzo Bagnardi4, Giovanni Mazzarol5, Oriana Pala5, Matteo Lazzeroni6, Germana Lissidini7, Mauro Giuseppe Mastropasqua2, Enrico Cassano1. 1. Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy. 2. Department of Emergency and Organ Transplantation, Section of Anatomic Pathology, School of Medicine, University "Aldo Moro", 70124 Bari, Italy. 3. Postgraduate School in Radiology, University of Milan, 20122 Milan, Italy. 4. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy. 5. Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy. 6. Division of Cancer Prevention and Genetics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy. 7. Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy.
Abstract
(1) Background: to evaluate which factors can reduce the upgrade rate of atypical ductal hyperplasia (ADH) to in situ or invasive carcinoma in patients who underwent vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. (2) Methods: 2955 VABBs were reviewed; 141 patients with a diagnosis of ADH were selected for subsequent surgical excision. The association between patients' characteristics and the upgrade rate to breast cancer was evaluated in both univariate and multivariate analyses. (3) Results: the upgrade rates to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) were, respectively, 29.1% and 7.8%. The pooled upgrade rate to DCIS or IC was statistically lower at univariate analysis, considering the following parameters: complete removal of the lesion (p-value < 0.001); BIRADS ≤ 4a (p-value < 0.001); size of the lesion ≤15 mm (p-value: 0.002); age of the patients <50 years (p-value: 0.035). (4) Conclusions: the overall upgrade rate of ADH to DCIS or IC is high and, as already known, surgery should be recommended. However, ADH cases should always be discussed in multidisciplinary meetings: some parameters appear to be related to a lower upgrade rate. Patients presenting these parameters could be strictly followed up to avoid overtreatment.
(1) Background: to evaluate which factors can reduce the upgrade rate of atypical ductal hyperplasia (ADH) to in situ or invasive carcinoma in patients who underwent vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. (2) Methods: 2955 VABBs were reviewed; 141 patients with a diagnosis of ADH were selected for subsequent surgical excision. The association between patients' characteristics and the upgrade rate to breast cancer was evaluated in both univariate and multivariate analyses. (3) Results: the upgrade rates to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) were, respectively, 29.1% and 7.8%. The pooled upgrade rate to DCIS or IC was statistically lower at univariate analysis, considering the following parameters: complete removal of the lesion (p-value < 0.001); BIRADS ≤ 4a (p-value < 0.001); size of the lesion ≤15 mm (p-value: 0.002); age of the patients <50 years (p-value: 0.035). (4) Conclusions: the overall upgrade rate of ADH to DCIS or IC is high and, as already known, surgery should be recommended. However, ADH cases should always be discussed in multidisciplinary meetings: some parameters appear to be related to a lower upgrade rate. Patients presenting these parameters could be strictly followed up to avoid overtreatment.
Entities:
Keywords:
BIRADS; atypical duct hyperplasia; breast biopsy; breast cancer; breast surgery; overtreatment; upgrade to cancer