Section of Surgical Oncology, Department of Surgery, Mayo Clinic Hospital, Mayo Clinic, Phoenix, AZ, USA.
Ann Surg Oncol. 2012 Oct;19(10):3264-9. doi: 10.1245/s10434-012-2575-0. Epub 2012 Aug 10.
Excisional biopsy is currently recommended for atypical ductal hyperplasia (ADH) diagnosed on core needle breast biopsy (CNB), due to risk of upstaging to invasive or in situ carcinoma (DCIS). The study goal was to identify patients who may potentially forego excisional biopsy if the risk of upstaging is low.
We conducted a retrospective review of patients diagnosed with ADH on CNB who underwent excisional biopsy at one institution (5/2000-5/2011). We evaluated the upstaging rate and clinicopathologic factors associated with increased upstaging risk.
A total of 114 cases of ADH were diagnosed on CNB. The median patient age was 64 years. On mammography, a mass/density/area of distortion was present in 23 % of cases; calcifications were present in 77 %. Most biopsies (79 %) were performed stereotactically. Twenty lesions (18 %) were upstaged to infiltrating carcinoma (5 %) or DCIS (13 %). Residual ADH was present in 43 biopsies (38 %). On univariate analysis, significant variables associated with upstaging included age >50 years, a mass lesion on mammography, and shorter length of biopsy core (p < 0.05). No patient ≤50 years of age was upstaged. Three patients who were not upstaged (3 %) developed ipsilateral disease (2 DCIS and 1 infiltrating ductal carcinoma) at a median time of 37 months.
The rate of upstaging when ADH is diagnosed on CNB at our institution is 18 %, and routine excisional biopsy is currently recommended for all patients. However, patients <50 years old with focal atypia only and no residual calcifications postbiopsy may represent a low-risk group who could potentially avoid excisional biopsy.
由于存在升级为浸润性癌或原位癌（DCIS）的风险，目前对于在核心针乳腺活检（CNB）中诊断为非典型导管增生（ADH）的患者，建议进行切除活检。本研究的目的是确定如果升级风险较低，哪些患者可能无需进行切除活检。
我们对在一家机构接受切除活检的在 CNB 中诊断为 ADH 的患者进行了回顾性研究（5/2000-5/2011）。我们评估了升级率和与升级风险增加相关的临床病理因素。
在 CNB 中诊断出 114 例 ADH。患者的中位年龄为 64 岁。在乳房 X 线摄影中，23%的病例存在肿块/密度/区域变形；77%的病例存在钙化。大多数活检（79%）是立体定向进行的。20 个病变（18%）升级为浸润性癌（5%）或 DCIS（13%）。43 个活检（38%）中仍存在 ADH。在单因素分析中，与升级相关的显著变量包括年龄>50 岁、乳房 X 线摄影中有肿块病变和活检芯长度较短（p<0.05）。≤50 岁的患者无一例升级。3 例未升级的患者（3%）在中位时间 37 个月后同侧发生疾病（2 例 DCIS 和 1 例浸润性导管癌）。
在我们机构，CNB 诊断为 ADH 时的升级率为 18%，目前建议所有患者进行常规切除活检。然而，<50 岁、仅存在局灶性不典型性且活检后无残留钙化的患者可能属于低风险组，他们可能可以避免切除活检。
