Atypical ductal hyperplasia and atypia of uncertain significance in core biopsies from mammographically detected lesions: correlation with excision diagnosis

• Published in: Pathology Vol. 34; no. 5; pp. 410 - 416
• Main Authors: Harvey, Jennet M., Sterrett, Gregory F., Frost, Felicity A.
• Format: Journal Article
• Language: English
• Published: London Elsevier B.V 2002; Informa UK Ltd; Taylor and Francis
• Subjects: Aged; atypical ductal hyperplasia; Biological and medical sciences; Biopsy, Needle; Breast - pathology; Breast - surgery; Breast carcinoma; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Carcinoma in Situ - epidemiology; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Female; Gynecology. Andrology. Obstetrics; Humans; Hyperplasia - pathology; local regression of DCIS; Mammary gland diseases; Mammography; Medical sciences; Middle Aged; Precancerous Conditions - epidemiology; Precancerous Conditions - pathology; Precancerous Conditions - surgery; Retrospective Studies; stereotactic core biopsy; Tumors; Western Australia; Western Australia; Breast carcinoma; local regression of DCIS; mammography; stereotactic core biopsy; atypical ductal hyperplasia; Surgical biopsy; Human; Ductal carcinoma; Prevalence; Breast disease; Radiodiagnosis; Hyperplasia; Mammography; Malignant tumor; Mammary gland diseases; Pathology; Concomitant disease; Cohort study; Female; Tumor; Atypical; Mammary gland
• ISSN: 0031-3025; 1465-3931
• DOI: 10.1080/0031302021000009315

To assess: (1) the prevalence of reporting of atypical ductal hyperplasia (ADH) and intraductal atypia of uncertain significance (AUS) in a series of core biopsies from mammo-graphically detected lesions, (2) the proportion of cases where excision revealed breast carcinoma, and (3) whether any diagnoses should be revised on review. Breast core biopsy reports from the Sir Charles Gairdner Hospital Breast Assessment Centre for the years 1999–2000 were retrieved. Slides from cases reported as ADH or AUS were reviewed as well as slides from the excision biopsies. There were 1048 core biopsies from 911 women. Breast carcinoma was diagnosed in 197 samples (18.8%) including 88 with invasive carcinoma (8.4%), 109 with ductal carcinoma in situ (DCIS) (10.4%). Three biopsies (0.3%) ‘suspicious’ of invasive carcinoma proved to be so. Of 52 samples (5.0%) with a diagnosis of ADH or AUS, 46 were excised, showing seven invasive carcinomas, 15 DCIS, 11 ADH, two lobular carcinoma in situ (LCIS), nine fibrocystic change (FCC), one mucocoele-like lesion and one fibroadenoma. The 22 malignancies represented 47.8% of the excised lesions. On review, seven of the 52 original core diagnoses were downgraded to benign hyperplasia. Five underwent excision, revealing two FCC, one complex sclerosing lesion, and two incidental lesions unrelated to the mammographic abnormality, including a microscopic tubular carcinoma and a focus of LCIS. In one case reviewed as unsatisfactory, excision showed invasive carcinoma. Lesions of particular interest included a case of high-grade DCIS with local regression in the core biopsy (so-called ‘burnt out DCIS’), and one case diagnosed on excision as micropapillary ADH, where the review diagnosis was micropapillary DCIS. ADH and AUS were reported in 5.0% of biopsies. There was a high rate of carcinoma (47.8%) in subsequent excisions. Very few diagnoses were revised on review. Current protocols for excision of lesions with a 14-gauge core biopsy diagnosis of ADH/AUS appear justified. Literature review suggests that vacuum-assisted core sampling with 11-gauge needles will not remove the need for excision. Further study of local regression of DCIS and micropapillary lesions will be worthwhile.