Department of Surgery, Gangnam CHA Medical Center, CHA University College of Medicine, Seoul, Republic of Korea;
Department of Diagnostic Radiology, Gangnam CHA Medical Center, CHA University College of Medicine, Seoul, Republic of Korea.
Anticancer Res. 2022 Apr;42(4):2159-2165. doi: 10.21873/anticanres.15698.
BACKGROUND/AIM: We conducted this single-center, retrospective study to identify predictors of upgrading to malignancy and to discuss the necessity of additional excision biopsy in patients who were diagnosed with atypical ductal hyperplasia (ADH) at ultrasound (US)-guided vacuum-assisted breast biopsy (VABB) based on our 18-year, single-center experience.
The current study was conducted in a total of 12,160 patients who were evaluated at our medical institution during an 18-year period between January of 2003 and December of 2020. We included the patients who were diagnosed with ADH at US-guided VABB using the Mammotome (Devicor Medical Products, Inc., Cincinnati, OH, USA). We therefore included a total of 114 patients (n=114) with ADH in the current study.
Of 114 eligible patients, 36 underwent additional excision biopsy and the remaining 78 did not. Of these 36 patients, 15 were found to have an upgrading to malignancy at a rate of upgrading of 41.7%. These include 7 cases (46.6%) of low-grade ductal carcinoma in situ (DCIS), 3 cases (20.0%) of intermediate grade DCIS, 1 case (6.7%) of microinvasive DCIS, 3 cases (20.0%) of multifocal lobular carcinoma in situ, and 1 case (6.7%) of mucinous carcinoma. Finally, only suspicious microcalcification on mammography was a significant predictor of upgrading to malignancy (p=0.023).
An additional excision biopsy is recommended to reduce the rate of upgrading to malignancy in patients who were diagnosed with ADH through a US-guided VABB.
背景/目的：我们进行了这项单中心回顾性研究，以确定在超声引导下真空辅助乳腺活检（VABB）中诊断为非典型导管增生（ADH）的患者中，向恶性肿瘤升级的预测因素，并根据我们 18 年的单中心经验，讨论在这些患者中进行额外切除活检的必要性。
本研究共纳入了 12160 例患者，他们在 2003 年 1 月至 2020 年 12 月的 18 年期间在我院进行了评估。我们纳入了在超声引导下使用 Mammotome（Devicor Medical Products，Inc.，Cincinnati，OH，USA）进行 VABB 诊断为 ADH 的患者。因此，本研究共纳入了 114 例 ADH 患者。
在 114 例符合条件的患者中，有 36 例行额外切除活检，其余 78 例未行。这 36 例患者中，有 15 例升级为恶性肿瘤，升级率为 41.7%。其中包括 7 例（46.6%）低级别导管原位癌（DCIS）、3 例（20.0%）中级 DCIS、1 例（6.7%）微浸润性 DCIS、3 例（20.0%）多灶性小叶原位癌和 1 例（6.7%）黏液癌。最后，仅乳腺 X 线摄影上可疑微钙化是向恶性肿瘤升级的显著预测因素（p=0.023）。
对于在超声引导下 VABB 中诊断为 ADH 的患者，建议进行额外的切除活检以降低向恶性肿瘤升级的比率。
