Department of Pathology, University of Washington Medical Center, Seattle, WA 98195, USA.
Hum Pathol. 2011 Jan;42(1):41-50. doi: 10.1016/j.humpath.2010.06.011. Epub 2010 Oct 20.
We evaluated 97 cases of review-confirmed atypical ductal hyperplasia found on stereotactic vacuum-assisted breast biopsy of suspicious calcifications. The number and size of foci of atypical ductal hyperplasia and presence of a micropapillary component were noted. In addition, we recorded if a case was considered "atypical ductal hyperplasia suspicious for ductal carcinoma in situ" using specific qualitative criteria. The upgrade rate was 20.6% (20/97) for all cases and 48% (12/25) for cases suspicious for ductal carcinoma in situ. Suspicion for ductal carcinoma in situ was found to be a strong predictor of upgrade with an odds ratio of 7.4 (P = .0003). Suspicious cases with nuclear features bordering on intermediate nuclear grade had the highest upgrade rate of 75% (6/8). Cases with ≥ 3 foci had significantly higher upgrade rates (28%) than those with less than 3 foci (11%), but focal atypical ductal hyperplasia did upgrade (P = .04). In conclusion, qualitative features of atypical ductal hyperplasia on core biopsy such as suspicion for ductal carcinoma in situ may help stratify patients at the highest risk for upgrade.
我们评估了 97 例在可疑钙化的立体定向真空辅助乳腺活检中发现的经审查证实的非典型导管增生。注意到非典型导管增生的焦点数量和大小以及微乳头状成分的存在。此外，如果根据特定的定性标准，病例被认为“非典型导管增生疑似导管原位癌”，我们也会记录下来。所有病例的升级率为 20.6%（20/97），疑似导管原位癌的病例为 48%（12/25）。疑似导管原位癌被发现是升级的强烈预测因素，优势比为 7.4（P=0.0003）。具有接近中等核级核特征的可疑病例的升级率最高，为 75%（6/8）。具有≥3 个焦点的病例的升级率明显高于具有小于 3 个焦点的病例（28%比 11%），但焦点性非典型导管增生确实会升级（P=0.04）。总之，核心活检中非典型导管增生的定性特征，如疑似导管原位癌，可能有助于分层具有最高升级风险的患者。
