Atypical ductal hyperplasia diagnosis by directional vacuum-assisted stereotactic biopsy of breast microcalcifications: Considerations for surgical excision

• Published in: American journal of clinical pathology Vol. 119; no. 2; pp. 248 - 253
• Main Authors: SNEIGE, Nour, LIM, Sung C, WHITMAN, Gary J, KRISHNAMURTHY, Savitri, SAHIN, Aysegul A, SMITH, Terry L, STELLING, Carol B
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Society of Clinical Pathologists 01.02.2003
• Subjects: Adult; Aged; Biological and medical sciences; Biopsy, Needle - instrumentation; Biopsy, Needle - methods; Breast Neoplasms - complications; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Calcinosis - diagnostic imaging; Calcinosis - etiology; Calcinosis - pathology; Calcinosis - surgery; Carcinoma, Ductal, Breast - complications; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - surgery; Female; Gynecology. Andrology. Obstetrics; Humans; Hyperplasia; Mammary gland diseases; Mammography; Medical sciences; Middle Aged; Precancerous Conditions - complications; Precancerous Conditions - pathology; Precancerous Conditions - surgery; Retrospective Studies; Stereotaxic Techniques; Tumors; Vacuum; Human; Nonpalpable breast lesions; Microcalcification; Premalignant lesion; Microcalcifications; Hyperplasia; Stereotaxia; Core needle biopsy; Mammotome; Mammary gland diseases; Biopsy; Surgery; Risk factor; Breast; Atypical; Vacuum-assisted stereotactic biopsy; Diagnosis; Mammary gland; Atypical ductal hyperplasia; Tumorectomy
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1309/0GYV4F2LLJAV4GFN

In 824 patients who underwent directional vacuum-assisted biopsies (DVABs) of breast microcalcifications, 61 (7.4%) showed atypical ductal hyperplasia (ADH). The 42 who subsequently underwent excision were the subjects of this study. Cases were evaluated for the mammographic characteristics of the lesion, the percentage of lesion removed according to mammography, and histologic findings (including number of large ducts and/or terminal duct-lobular units involved with ADH) in DVAB specimens. Pathologic findings in the surgical specimens in the area of the biopsy site also were recorded. In the DVAB specimens, ADH was confined to an average of 1.5 large ducts or lobular units and was associated with microcalcifications in all of the patients. Surgical specimens showed ADH in 15 cases, no residual lesion in 24 cases, and ductal carcinoma in situ in 3 cases. We found that microcalcifications that contain ADH in less than 3 lobules or ducts and/or that are removed completely by DVAB do not reveal higher-risk lesions on excision; thus, removal is unnecessary. When assessing microcalcifications with ADH, clinicians should consider the percentage of microcalcifications removed by DVAB and the extent of lobular involvement to better assess the need for excision.