Atypical Ductal Hyperplasia in Directional Vacuum-Assisted Biopsy of Breast Microcalcifications: Considerations for Surgical Excision

• Published in: Annals of surgical oncology Vol. 18; no. 3; pp. 752 - 761
• Main Authors: Nguyen, Christopher V., Albarracin, Constance T., Whitman, Gary J., Lopez, Adriana, Sneige, Nour
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-03-2011; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Breast Neoplasms - complications; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Oncology; Calcinosis - etiology; Calcinosis - pathology; Calcinosis - surgery; Carcinoma in Situ - complications; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Carcinoma, Ductal, Breast - complications; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - surgery; Female; Humans; Hyperplasia - complications; Hyperplasia - pathology; Hyperplasia - surgery; Medicine; Medicine & Public Health; Middle Aged; Oncology; Preoperative Care; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Vacuum; Atypical Ductal Hyperplasia; Atypical Ductal Hyperplasia Lesion; Residual Calcification; Micropapillary Pattern; Core Needle Biopsy
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-010-1127-8

Background
Our goal was to analyze clinicopathologic features of patients with atypical ductal hyperplasia (ADH) diagnosed on directional vacuum-assisted biopsy (DVAB) targeting microcalcifications to identify factors predicting the presence of carcinoma.
Materials and Methods
We retrospectively evaluated the clinical, mammographic, and histologic features of 140 patients with DVAB-diagnosed ADH who underwent either segmental excision (86.4%) or mammographic follow-up (≥2 years; 13.6%). Cases with mass lesions or ipsilateral cancer were excluded.
Results
In 16 cases, carcinoma was found on excision. All cases without excision showed no new abnormalities on mammographic follow-up. Only the amount of calcifications removed (≤95%) significantly correlated with the rate of upgrade of ADH to carcinoma (
P
 = .037). Significant histologic predictors of upgrade to carcinoma included number of terminal duct-lobular units (TDLU; >2) involved (
P
 = .0306), presence of significant cytologic atypia suspicious for intermediate or high-grade carcinoma (
P
 < .0001), and necrosis (
P
 = .0006). Among ADH cases without significant atypia and/or necrosis, the extent of ADH (≤2 vs. >2 TDLU involved) was not a significant predictor of carcinoma (
P
 = 1.0000).
Conclusions
ADH associated with calcifications in the absence of a mass lesion can be categorized into different risk groups using a multidisciplinary approach with correlation of histologic and mammographic findings. ADH lesions with significant cytologic atypia and/or necrosis are most likely to be associated with carcinoma and should be excised. ADH without these features, regardless of extent of involvement, and with >95% removal of the targeted calcifications, is associated with a minimal risk (<3%) of carcinoma and may undergo mammographic follow-up only.