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When Does Atypical Ductal Hyperplasia Require Surgical Excision?

Jennifer M Racz1, Amy C Degnim1

  • 1Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.

Surgical Oncology Clinics of North America
|November 15, 2017
PubMed
Summary
This summary is machine-generated.

Atypical ductal hyperplasia (ADH) diagnosis may not always require surgical excision. Certain criteria suggest a low risk of missed cancer, potentially avoiding unnecessary surgery for breast lesions.

Keywords:
Atypical ductal hyperplasiaCore needle biopsyEpithelial proliferative lesionSurgical excision

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Area of Science:

  • Oncology
  • Pathology
  • Radiology

Background:

  • Atypical ductal hyperplasia (ADH) is a breast lesion indicating elevated breast cancer risk.
  • Surgical excision is the current standard after ADH diagnosis via core needle biopsy.

Purpose of the Study:

  • To identify criteria for predicting a low risk of malignancy in ADH cases.
  • To evaluate if selected ADH cases can forgo surgical excision.

Main Methods:

  • Retrospective analysis of core needle biopsy and subsequent excision data.
  • Assessment of lesion characteristics: presence of mass, imaging-pathology concordance, calcification removal percentage, affected terminal duct lobular units (TDLUs), and presence of atypia or necrosis.

Main Results:

  • Specific criteria (no mass, concordance, ≥90% calcification removal, ≤2 TDLUs, no atypia/necrosis) were associated with <5%missed cancer rate.
  • These findings suggest a subset of ADH cases have a very low risk of harboring invasive carcinoma.

Conclusions:

  • Selected ADH cases meeting specific imaging and pathologic criteria may not require routine surgical excision.
  • This research could refine management guidelines for ADH, potentially reducing overtreatment.