Hodorowicz-Zaniewska Diana, Brzuszkiewicz Karolina, Szpor Joanna, Kibil Wojciech, Matyja Andrzej, Dyląg-Trojanowska Katarzyna, Richter Piotr, Szczepanik Antoni M
First Chair of General Surgery, Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Krakow, Poland.
Chair of Pathomorphology, Jagiellonian University Medical College, Krakow, Poland.
Wideochir Inne Tech Maloinwazyjne. 2018 Jun;13(2):184-191. doi: 10.5114/wiitm.2018.73528. Epub 2018 Feb 15.
Atypical ductal hyperplasia (ADH) is a benign lesion, which due to the risk of coexisting cancer is classified as a lesion of uncertain malignant potential.
To identify clinical predictors of cancer underestimation in patients with ADH diagnosed after vacuum-assisted breast biopsy (VABB).
Between 2001 and 2016, a total of 3804 vacuum-assisted core needle biopsies were performed at the First Chair of General Surgery of the Jagiellonian University Medical College in Krakow, including 2907 ultrasound (US)-guided biopsies and 897 digital stereotactic procedures. Seventy-six women were diagnosed with ADH and 72 of them underwent subsequent surgical excision. Demographic factors, medical history, family history, clinical symptoms, type and size of lesion determined in imaging scans, size of biopsy needle, and presence of coexisting lesions in VABB specimens were analysed as potential predictors of malignancy underestimation.
Underestimation of breast carcinoma occurred in 21 (29.2%) patients. The upgrade rate was significantly higher only in patients with a lesion visible both in mammography (MMG) and US examinations and combined BIRADS-5.
Vacuum-assisted core needle biopsy is a minimally invasive technique used in diagnosing ADH. As the risk of breast malignancy underestimation is relatively high, open surgical biopsy remains the recommended procedure, especially in patients with lesions detected both in mammography and US examination. As we could not identify the factors that preclude cancer underestimation, all the women diagnosed with ADH should be informed about the risk of cancer underestimation.
非典型导管增生（ADH）是一种良性病变，因其存在共存癌症的风险而被归类为恶性潜能不确定的病变。
确定在真空辅助乳腺活检（VABB）后诊断为ADH的患者中癌症低估的临床预测因素。
2001年至2016年期间，克拉科夫雅盖隆大学医学院普通外科第一教研室共进行了3804例真空辅助芯针活检，其中包括2907例超声（US）引导下活检和897例数字立体定向手术。76名女性被诊断为ADH，其中72名随后接受了手术切除。分析人口统计学因素、病史、家族史、临床症状、影像学扫描确定的病变类型和大小、活检针大小以及VABB标本中是否存在共存病变，作为恶性低估的潜在预测因素。
21例（29.2%）患者出现乳腺癌低估。仅在乳腺钼靶（MMG）和超声检查中均可见病变且BIRADS分类为5类的患者中，升级率显著更高。
真空辅助芯针活检是用于诊断ADH的一种微创技术。由于乳腺癌低估的风险相对较高，开放手术活检仍是推荐的方法，尤其是对于在乳腺钼靶和超声检查中均检测到病变的患者。由于我们无法确定可排除癌症低估的因素，所有被诊断为ADH的女性都应被告知癌症低估的风险。
