Zaveri Shruti, Sun Susie X, Bevers Therese B, Albarracin Constance T, Bedrosian Isabelle
Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2025 Sep 4. doi: 10.1245/s10434-025-18236-2.
The recently reported results from the COMET trial investigating the nonoperative management of low-risk ductal carcinoma in situ (DCIS) question the need for routine excision of atypical ductal hyperplasia (ADH). This study aimed to examine the upgrade rates of patients with ADH who met applicable COMET trial criteria.
Cases of ADH managed with surgery at our institution between 2004 and 2022 were identified, and clinical variables were extracted from the medical record. Rates of ADH upgrade to in situ and invasive disease were compared between patients who met the selected COMET criteria for age, imaging findings, and personal history of breast cancer and those who did not.
Of the 362 ADH cases that met the inclusion criteria for this study; 233 (64.4 %) met the selective COMET criteria (cohort 1) and 129 (35.6 %) did not (cohort 2). The two cohorts did not differ significantly in terms of age, race, breast density, or size of lesion on imaging. The cohort 1 patients were more likely to have their diagnosis determined by mammography (94 % vs 72 %; p < 0.01) and more likely to present with calcifications (82 % vs 30.2 %; p < 0.01). The rate of upgrade to DCIS did not differ significantly between the cohorts, but the rate of invasive disease was significantly lower in cohort 1 (3.43 % vs 10.85 %; p < 0.01).
The study data showed a very low rate of ADH upgrade to invasive disease for the patients who met the COMET criteria for age, imaging findings, and breast cancer history, suggesting that such patients also could be considered a low-risk cohort for whom observation might be appropriate.
最近公布的COMET试验结果对低风险导管原位癌（DCIS）的非手术治疗进行了研究，对非典型导管增生（ADH）进行常规切除的必要性提出了质疑。本研究旨在检查符合适用的COMET试验标准的ADH患者的升级率。
确定2004年至2022年期间在本机构接受手术治疗的ADH病例，并从病历中提取临床变量。比较符合所选COMET年龄、影像学表现和乳腺癌个人史标准的患者与不符合这些标准的患者中ADH升级为原位癌和浸润性疾病的发生率。
在符合本研究纳入标准的362例ADH病例中，233例（64.4%）符合选择性COMET标准（队列1），129例（35.6%）不符合（队列2）。两组在年龄、种族、乳腺密度或影像学上的病变大小方面无显著差异。队列1中的患者更有可能通过乳腺X线摄影确定诊断（94%对72%；p<0.01），更有可能出现钙化（82%对30.2%；p<0.01）。两组之间升级为DCIS的发生率无显著差异，但队列1中浸润性疾病的发生率显著较低（3.43%对10.85%；p<0.01）。
研究数据显示，对于符合年龄、影像学表现和乳腺癌病史COMET标准的患者，ADH升级为浸润性疾病的发生率非常低，这表明此类患者也可被视为观察可能合适的低风险队列。
