Caplain Alizée, Drouet Youenn, Peyron Mathilde, Peix Marie, Faure Christelle, Chassagne-Clément Catherine, Beurrier Frédéric, Fondrevelle Marie-Eve, Guérin Nicole, Lasset Christine, Treilleux Isabelle
Department of Oncologic Surgery, Centre Léon Bérard, Lyon, France.
Department of Public Health, Centre Léon Bérard, Lyon, France; Université Lyon 1, CNRS UMR 5558, Centre Léon Bérard, Lyon, France.
Am J Surg. 2014 Aug;208(2):260-7. doi: 10.1016/j.amjsurg.2013.10.029. Epub 2014 Jan 23.
Because of underestimation, surgical excision is recommended for atypical ductal hyperplasia diagnosed on directional vacuum-assisted biopsies. The following guidelines have been established according to our retrospective study published in 2008: excision for lesions ≥ 21 mm, follow-up for lesions <6 mm with complete removal of microcalcifications, and follow-up or excision for 6 to 21-mm lesions with respectively less or >2 atypical ductal hyperplasia foci.
These guidelines were assessed in a prospective series of 124 patients with a median follow-up of 30 months. Conformity rate was 92%. Upgrading was 28% (15 of 53 patients) for conformed surgery and absent for surgery performed beyond the scope of guidelines. For the patients with benign result at surgery (n = 38) or just followed (n = 61), 3 cancers occurred in either breast at 1 to 3 years.
These convenient guidelines can safely spare surgery for a subset of patients. However, annual mammographic follow-up is recommended since the risk of subsequent cancer remains high for both breasts.
