The Breast
Volume 20, Issue 1 , Pages 50-55, February 2011

Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy

  • Isabelle Deshaies

      Affiliations

    • Centre des Maladies du Sein Deschênes–Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Département de chirurgie, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6
    • ,
  • Louise Provencher

      Affiliations

    • Centre des Maladies du Sein Deschênes–Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Santé des populations: URESP, Centre de recherche FRSQ du Centre hospitalier affilié universitaire de Québeca, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Département de chirurgie, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6
    • ,
  • Simon Jacob

      Affiliations

    • Centre des Maladies du Sein Deschênes–Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Santé des populations: URESP, Centre de recherche FRSQ du Centre hospitalier affilié universitaire de Québeca, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Département de biologie moléculaire, biochimie médical et pathologie, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6
    • ,
  • Gary Côté

      Affiliations

    • Centre des Maladies du Sein Deschênes–Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Département de radiologie, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6
    • ,
  • Jean Robert

      Affiliations

    • Centre des Maladies du Sein Deschênes–Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Santé des populations: URESP, Centre de recherche FRSQ du Centre hospitalier affilié universitaire de Québeca, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Département de chirurgie, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6
    • ,
  • Christine Desbiens

      Affiliations

    • Centre des Maladies du Sein Deschênes–Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Santé des populations: URESP, Centre de recherche FRSQ du Centre hospitalier affilié universitaire de Québeca, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Département de chirurgie, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6
    • ,
  • Brigitte Poirier

      Affiliations

    • Centre des Maladies du Sein Deschênes–Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Santé des populations: URESP, Centre de recherche FRSQ du Centre hospitalier affilié universitaire de Québeca, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Département de chirurgie, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6
    • ,
  • Jean-Charles Hogue

      Affiliations

    • Centre des Maladies du Sein Deschênes–Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • ,
  • Éric Vachon

      Affiliations

    • Centre des Maladies du Sein Deschênes–Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • ,
  • Caroline Diorio

      Affiliations

    • Centre des Maladies du Sein Deschênes–Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Santé des populations: URESP, Centre de recherche FRSQ du Centre hospitalier affilié universitaire de Québeca, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8
    • Département de médecine sociale et préventive, Université Laval, Pavillon Ferdinand-Vandry, 1050 ave de la Médecine, Quebec City, QC, Canada G1V 0A6
    • Corresponding Author InformationCorresponding author. Tel.: +418 682 7390; fax: +418 682 7949.

Received 19 April 2010; received in revised form 14 June 2010; accepted 15 June 2010. published online 09 July 2010.

Abstract 

Previous studies have shown that 4–54% of breast lesions reported on core biopsies as atypical ductal hyperplasia (ADH) are upgraded on further excision to ductal carcinoma in situ (DCIS) or invasive carcinoma. We evaluated the rate of upgrading ADH to carcinoma at surgery for ADH diagnosed by percutaneous biopsy, and examined characteristics associated with malignancy. We identified 13,488 consecutive biopsies conducted at one center over a nine-year period. A total of 422 biopsies with ADH in 415 patients were included. DCIS or invasive carcinoma was found in 132 cases (31.3% upgrading). Multivariate model revealed that ipsilateral breast symptoms, mammographic lesion other than microcalcifications alone, 14G core needle biopsy, papilloma co-diagnosis, severe ADH and pathologists with lower volume of ADH diagnosis were factors statistically associated with malignancy. However, no subgroups were identified for safe clinical-only follow-up. Surgery is recommended in all cases of ADH diagnosed by percutaneous breast biopsy.

Keywords: Atypical ductal hyperplasia, Carcinoma, Core needle biopsy, Vacuum-assisted biopsy, Upgrading rate, Underestimation

Abbreviations used: ADH, Atypical ductal hyperplasia, DCIS, Ductal carcinoma in situ, CNB, Core needle biopsy, VAB, Vacuum-assisted biopsy

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PII: S0960-9776(10)00154-2

doi:10.1016/j.breast.2010.06.004

The Breast
Volume 20, Issue 1 , Pages 50-55, February 2011

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