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Ipsilateral and Concurrent Breast Cancer and Atypical Ductal Hyperplasia: Does Atypia Also Need Surgical Excision?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Standard-of-care management of atypical ductal hyperplasia (ADH) is surgical excision. Multiple studies have identified features of ADH in patients at low risk for upgrade who may benefit from omission of surgical excision. Patients with an ipsilateral breast cancer have been excluded from studies investigating observation for the management of ADH.

Methods

This was a retrospective review of women with both a breast cancer and an ipsilateral separate site of ADH diagnosed on percutaneous biopsy, who underwent excision of both sites from 2008 to 2018. Radiographic and pathologic features of ADH and cancer were analyzed, including imaging size, biopsy modality, distance between sites, cancer subtype, grade, prognostic markers, ADH foci, and presence of necrosis or micropapillary features. Final pathology at the ADH site was used to determine upgrade. Multivariable logistic regression was performed to identify variables significantly associated with ADH upgrade to malignancy.

Results

Among 62 women meeting the inclusion criteria, 11 (17.7%) upgraded to malignancy [9 ductal carcinoma in situ (DCIS), 2 invasive cancer] at the site of ADH. Upgrade was significantly higher with ipsilateral DCIS (p = 0.03), ultrasound biopsy at the ADH site (p = 0.01), and ADH with necrosis (p = 0.04). The group at lowest risk for upgrade had stereotactic biopsy and ADH without necrosis (0% upgrade).

Conclusion

The presence of breast cancer does not significantly increase the likelihood for upgrade at a separate site of ipsilateral concurrent ADH above contemporary reported upgrade rates of ADH alone (10–30%). When considering breast conservation for breast cancer, omitting excision of the site of ADH can be considered when low-risk features are present.

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Acknowledgements

I would like to thank my thesis advisor Dr. Sue Min Lai for her assistance on this project, along with my thesis committee chairwomen, Drs. Wagner, Winblad, and Fan, for their support of this project as content experts. I would particularly like to recognize Dr. Fan, who personally reviewed the biopsy pathology slides to confirm the diagnosis of ADH and to document ADH characteristics, which were not routinely reported in the pathology report. Without her assistance, this project and its conclusions would not be possible. The authors would like to recognize Sue Min Lai, MS MBA Ph.D., for her assistance with this project as my Master in Clincal Research thesis advisor and Holly Zink, MSA, for providing medical writing and editorial support for this project.

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Authors and Affiliations

  1. Department of Surgery, The University of Kansas Health System, Kansas City, KS, USA

    Amanda L. Amin MD, MS, Kelsey E. Larson MD & Jamie L. Wagner DO

  2. Department of Pathology, The University of Kansas Health System, Kansas City, KS, USA

    Fang Fan MD, PhD

  3. Department of Radiology, The University of Kansas Health System, Kansas City, KS, USA

    Onalisa D. Winblad MD

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  1. Amanda L. Amin MD, MS
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  2. Fang Fan MD, PhD
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  3. Onalisa D. Winblad MD
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  5. Jamie L. Wagner DO
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Correspondence to Amanda L. Amin MD, MS.

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Disclosures

Amanda L. Amin, Fang Fan, Onalisa D. Winblad, Kelsey E. Larson, and Jamie L. Wagner have no commercial interests to disclose.

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Amin, A.L., Fan, F., Winblad, O.D. et al. Ipsilateral and Concurrent Breast Cancer and Atypical Ductal Hyperplasia: Does Atypia Also Need Surgical Excision?. Ann Surg Oncol 27, 4786–4794 (2020). https://doi.org/10.1245/s10434-020-08896-7

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