Abstract
Background
Atypical duct hyperplasia (ADH) observed during core needle biopsy is associated with a high rate of cancer upon excision. Controversy exists regarding the need to re-excise ADH involving a margin. The purpose of this study was to determine the rate of residual pathology in patients that underwent re-excision for ADH involving the margin.
Methods
In a retrospective review of the pathology database from 1 January 2000 to 1 June 2006, we identified 44 lumpectomy specimens with ADH involving the margin; 24 patients (55%) had a re-excision. Slides were reviewed to verify the diagnosis of ADH near the margin and the presence of residual disease on re-excision associated with the biopsy cavity.
Results
Patients had pure ADH (15, 63%), ADH and ductal carcinoma in situ (DCIS) (7, 29%) or ADH with invasive carcinoma (2, 8%). Residual ADH or cancer was found in 14 of 24 patients (58%). Of 15 patients with pure ADH, 6 (40%) had residual pathology: ADH (2), DCIS (2) and invasive carcinoma (2). In this group, 27% of patients were reassessed as having DCIS or invasive carcinoma. Of the 9 patients with cancer, 8 (89%) had residual disease in the form of ADH (4) or DCIS (4).
Conclusions
ADH found at the margin of a lumpectomy specimen is associated with a high rate of residual ADH and cancer. Over one quarter of the patients with an initial diagnosis of ADH were reassessed as having DCIS or invasive carcinoma. Re-excision in all patients with ADH involving the margin is recommended.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Page DL, Dupont WD. Anatomic markers of human premalignancy and risk of breast cancer. Cancer 1990; 66:1326–35
Sewell CW. Pathology of high-risk breast lesions and ductal carcinoma in situ. Radiol Clin North Am 2004; 42:821–30
Houssami N, Ciatto S, Ellis I, Ambrogetti D. Underestimation of malignancy of breast core-needle biopsy. Cancer 2007; 109:487–95
Greene T, Tartter PI, Rosenbaum Smith S, Estabrook A. The significance of surgical margins for patients with atypical ductal hyperplasia. Am J Surg 2006; 192:499–501
Goldstein NS, Lacerna M, Vicini F. Cancerization of lobules and atypical ductal hyperplasia adjacent to ductal carcinoma in situ of the breast. Significance for breast-conserving therapy. Am J Clin Pathol 1998; 110:357–67
Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasia. Hum Pathol 1992; 23:1095–7
Tavassoli FA, Norris HJ. A comparison of the results of long-term follow-up for atypical intraductal hyperplasia and intraductal hyperplasia of the breast. Cancer 1990; 65:518–29
Page DL, Dupont WD, Rogers LW, Rados MS. Atypical hyperplastic lesions of the female breast. A long-term follow-up study. Cancer 1985; 55:2698–708
Ghofrani M, Tapia B, Tavassoli FA. Discrepancies in the diagnosis of intraductal proliferative lesions of the breast and its management implications: results of a multinational survey. Virchows Arch 2006; 449:609–16
Neuschatz AC, DiPetrillo T, Steinhoff M, Safaii H, et al. The value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast. Cancer 2002; 94(7):1917–24
Wazer DE, Schmidt-Ullrich RK, Schmid CH, Ruthazer R, et al. The value of breast lumpectomy margin assessment as a predictor of residual tumor burden. Int J Radiat Oncol Biol Phys 1997; 38(2):291–9
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Arora, S., Menes, T.S., Moung, C. et al. Atypical Ductal Hyperplasia at Margin of Breast Biopsy—Is Re-Excision Indicated?. Ann Surg Oncol 15, 843–847 (2008). https://doi.org/10.1245/s10434-007-9681-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-007-9681-4