Atypical Ductal Hyperplasia at Margin of Breast Biopsy—Is Re-Excision Indicated?

• Published in: Annals of surgical oncology Vol. 15; no. 3; pp. 843 - 847
• Main Authors: Arora, Shalini, Menes, Tehillah S., Moung, Christine, Nagi, Chandandeep, Bleiweiss, Ira, Jaffer, Shabnam
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.03.2008; Springer Nature B.V
• Subjects: Biopsy, Needle; Breast - pathology; Breast Oncology; Carcinoma, Ductal, Breast - pathology; Carcinoma, Intraductal, Noninfiltrating - pathology; Female; Humans; Hyperplasia; Medicine; Medicine & Public Health; Neoplasm, Residual - pathology; Oncology; Reoperation; Retrospective Studies; Surgery; Surgical Oncology; Lumpectomy; Breast; Margins; Re-excision; Atypical duct hyperplasia
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-007-9681-4

Background Atypical duct hyperplasia (ADH) observed during core needle biopsy is associated with a high rate of cancer upon excision. Controversy exists regarding the need to re-excise ADH involving a margin. The purpose of this study was to determine the rate of residual pathology in patients that underwent re-excision for ADH involving the margin. Methods In a retrospective review of the pathology database from 1 January 2000 to 1 June 2006, we identified 44 lumpectomy specimens with ADH involving the margin; 24 patients (55%) had a re-excision. Slides were reviewed to verify the diagnosis of ADH near the margin and the presence of residual disease on re-excision associated with the biopsy cavity. Results Patients had pure ADH (15, 63%), ADH and ductal carcinoma in situ (DCIS) (7, 29%) or ADH with invasive carcinoma (2, 8%). Residual ADH or cancer was found in 14 of 24 patients (58%). Of 15 patients with pure ADH, 6 (40%) had residual pathology: ADH (2), DCIS (2) and invasive carcinoma (2). In this group, 27% of patients were reassessed as having DCIS or invasive carcinoma. Of the 9 patients with cancer, 8 (89%) had residual disease in the form of ADH (4) or DCIS (4). Conclusions ADH found at the margin of a lumpectomy specimen is associated with a high rate of residual ADH and cancer. Over one quarter of the patients with an initial diagnosis of ADH were reassessed as having DCIS or invasive carcinoma. Re-excision in all patients with ADH involving the margin is recommended.