Annals of Surgical Oncology

, Volume 24, Issue 10, pp 2848–2854 | Cite as

Lobular Neoplasia and Atypical Ductal Hyperplasia on Core Biopsy: Current Surgical Management Recommendations

  • Jennifer M. Racz
  • Jodi M. Carter
  • Amy C. Degnim
Breast Oncology
Lobular neoplasia and atypical ductal hyperplasia (ADH) are high-risk breast lesions associated with an increased risk of breast cancer. Until recently, surgical excision was recommended for all patients with a percutaneous image-guided core needle biopsy (CNB) suggestive of either lobular neoplasia or ADH. However, the identification of patients who may be spared surgery is an area of active investigation. This report reviews both lobular neoplasia and ADH and provides recommendations for clinical management (summarized in Table  1).
Table 1

Summary of management recommendations for lobular neoplasia and atypical ductal hyperplasia

Core needle biopsy pathology

Risk association

Surgical excision



Lobular neoplasia

Risk of upgrade to invasive carcinoma:

  ALH ~1–3%

  LCIS ~1–8%

Yes, particularly for variant (non-classic) forms of LCIS; may still be considered for classic LCIS

May be appropriate if:

 –Concordant histologic and mammographic findings (i.e., lobular...



The authors have no conflicts of interest to disclose.


  1. 1.
    Foote FW, Stewart FW. Lobular carcinoma in situ: a rare form of mammary cancer. Am J Pathol. 1941;17:491–6.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Haagensen CD, Lane N, Lattes R, Bodian C. Lobular neoplasia (so-called lobular carcinoma in situ) of the breast. Cancer. 1978;42:737–69.PubMedCrossRefGoogle Scholar
  3. 3.
    Page DL, Kidd TE, Jr., Dupont WD, et al. Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol. 1991;22:1232–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Tavassoli FA. Lobular neoplasia: evolution of its significance and morphologic spectrum. Int J Surg Pathol. 2010;18:174S–7S.PubMedCrossRefGoogle Scholar
  5. 5.
    Rosen PP, Kosloff C, Lieberman PH, et al. Lobular carcinoma in situ of the breast: detailed analysis of 99 patients with average follow-up of 24 years. Am J Surg Pathol. 1978;2:225–51.PubMedCrossRefGoogle Scholar
  6. 6.
    Chuba PJ, Hamre MR, Yap J, et al. Bilateral risk for subsequent breast cancer after lobular carcinoma in situ: analysis of surveillance, epidemiology, and end results data. J Clin Oncol. 2005;23:5534–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Page DL, Dupont WD, Rogers LW. Ductal involvement by cells of atypical lobular hyperplasia in the breast: a long-term follow-up study of cancer risk. Hum Pathol. 1988;19:201–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Degnim AC, Brahmbhatt RD, Radisky DC, et al. Immune cell quantitation in normal breast tissue lobules with and without lobulitis. Breast Cancer Res Treat. 2014;144:539–49.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Degnim AC, Dupont WD, Radisky DC, et al. Extent of atypical hyperplasia stratifies breast cancer risk in 2 independent cohorts of women. Cancer. 2016;122:2971–8.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Coopey SB, Mazzola E, Buckley JM, et al. The role of chemoprevention in modifying the risk of breast cancer in women with atypical breast lesions. Breast Cancer Res Treat. 2012;136:627–33.PubMedCrossRefGoogle Scholar
  11. 11.
    King TA, Pilewskie M, Muhsen S, et al. Lobular carcinoma in situ: a 29-year longitudinal experience evaluating clinicopathologic features and breast cancer risk. J Clin Oncol. 2015;33:3945–52.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Menes TS, Rosenberg R, Balch S, et al. Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium. Am J Surg. 2014;207:24–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Chang Sen LQ, Berg WA, Hooley RJ, et al. Core breast biopsies showing lobular carcinoma in situ should be excised and surveillance is reasonable for atypical lobular hyperplasia. AJR Am J Roentgenol. 2016;207:1132–45.CrossRefGoogle Scholar
  14. 14.
    Meroni S, Bozzini AC, Pruneri G, et al. Underestimation rate of lobular intraepithelial neoplasia in vacuum-assisted breast biopsy. Eur Radiol. 2014;24:1651–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Atkins KA, Cohen MA, Nicholson B, Rao S. Atypical lobular hyperplasia and lobular carcinoma in situ at core breast biopsy: use of careful radiologic-pathologic correlation to recommend excision or observation. Radiology. 2013;269:340–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Chaudhary S, Lawrence L, McGinty G, et al. Classic lobular neoplasia on core biopsy: a clinical and radio-pathologic correlation study with follow-up excision biopsy. Mod Pathol. 2013;26:762–71.PubMedCrossRefGoogle Scholar
  17. 17.
    Murray MP, Luedtke C, Liberman L, et al. Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: outcomes of prospective excision. Cancer. 2013;119:1073–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Bianchi S, Bendinelli B, Castellano I, et al. Morphological parameters of lobular in situ neoplasia in stereotactic 11-gauge vacuum-assisted needle core biopsy do not predict the presence of malignancy on subsequent surgical excision. Histopathology. 2013;63:83–95.PubMedCrossRefGoogle Scholar
  19. 19.
    Ibrahim N, Bessissow A, Lalonde L, et al. Surgical outcome of biopsy-proven lobular neoplasia: is there any difference between lobular carcinoma in situ and atypical lobular hyperplasia? AJR Am J Roentgenol. 2012;198:288–91.PubMedCrossRefGoogle Scholar
  20. 20.
    Lewis JL, Lee DY, Tartter PI. The significance of lobular carcinoma in situ and atypical lobular hyperplasia of the breast. Ann Surg Oncol. 2012;19:4124–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Polat AK, Kanbour-Shakir A, Andacoglu O, et al. Atypical hyperplasia on core biopsy: is further surgery needed? Am J Med Sci. 2012;344:28–31.PubMedCrossRefGoogle Scholar
  22. 22.
    Shah-Khan MG, Geiger XJ, Reynolds C, et al. Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. Ann Surg Oncol. 2012;19:3131–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Niell B, Specht M, Gerade B, Rafferty E. Is excisional biopsy required after a breast core biopsy yields lobular neoplasia? AJR Am J Roentgenol. 2012;199:929–35.PubMedCrossRefGoogle Scholar
  24. 24.
    Rendi MH, Dintzis SM, Lehman CD, et al. Lobular in situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. Ann Surg Oncol. 2012;19:914–21.PubMedCrossRefGoogle Scholar
  25. 25.
    Rakha EA, Ho BC, Naik V, et al. Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy, including detailed review of epithelial atypia. Histopathology. 2011;58:626–32.PubMedCrossRefGoogle Scholar
  26. 26.
    Flegg KM, Flaherty JJ, Bicknell AM, Jain S. Surgical outcomes of borderline breast lesions detected by needle biopsy in a breast screening program. World J Surg Oncol. 2010;8:78.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Gao F, Carter G, Tseng G, Chivukula M. Clinical importance of histologic grading of lobular carcinoma in situ in breast core needle biopsy specimens: current issues and controversies. Am J Clin Pathol. 2010;133:767–71.PubMedCrossRefGoogle Scholar
  28. 28.
    Purdie CA, McLean D, Stormonth E, et al. Management of in situ lobular neoplasia detected on needle core biopsy of breast. J Clin Pathol. 2010;63:987–93.PubMedCrossRefGoogle Scholar
  29. 29.
    O’Neil M, Madan R, Tawfik OW, et al. Lobular carcinoma in situ/atypical lobular hyperplasia on breast needle biopsies: does it warrant surgical excisional biopsy? A study of 27 cases. Ann Diagn Pathol. 2010;14:251–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Subhawong AP, Subhawong TK, Khouri N, et al. Incidental minimal atypical lobular hyperplasia on core needle biopsy: correlation with findings on follow-up excision. Am J Surg Pathol. 2010;34:822–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Graesslin O, Antoine M, Chopier J, et al. Histology after lumpectomy in women with epithelial atypia on stereotactic vacuum-assisted breast biopsy. Eur J Surg Oncol. 2010;36:170–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Mulheron B, Gray RJ, Pockaj BA, Apsey H. Is excisional biopsy indicated for patients with lobular neoplasia diagnosed on percutaneous core needle biopsy of the breast? Am J Surg. 2009;198:792–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Polom K, Murawa D, Pawelska A, Murawa P. Atypical lobular hyperplasia and lobular carcinoma in situ without other high-risk lesions diagnosed on vacuum-assisted core needle biopsy: the problem of excisional biopsy. Tumori. 2009;95:32–5.PubMedGoogle Scholar
  34. 34.
    Brem RF, Lechner MC, Jackman RJ, et al. Lobular neoplasia at percutaneous breast biopsy: variables associated with carcinoma at surgical excision. AJR Am J Roentgenol. 2008;190:637–41.PubMedCrossRefGoogle Scholar
  35. 35.
    Cangiarella J, Guth A, Axelrod D, et al. Is surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy? A report of 38 cases and review of the literature. Arch Pathol Lab Med. 2008;132:979–83.PubMedGoogle Scholar
  36. 36.
    Londero V, Zuiani C, Linda A, et al. Lobular neoplasia: core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features. Breast. 2008;17:623–30.PubMedCrossRefGoogle Scholar
  37. 37.
    Sohn VY, Arthurs ZM, Kim FS, Brown TA. Lobular neoplasia: is surgical excision warranted? Am Surg. 2008;74:172–7.PubMedGoogle Scholar
  38. 38.
    Menon S, Porter GJ, Evans AJ, et al. The significance of lobular neoplasia on needle core biopsy of the breast. Virchows Arch. 2008;452:473–9.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Nagi CS, O’Donnell JE, Tismenetsky M, et al. Lobular neoplasia on core needle biopsy does not require excision. Cancer. 2008;112:2152–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Hwang H, Barke LD, Mendelson EB, Susnik B. Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary. Mod Pathol. 2008;21:1208–16.PubMedCrossRefGoogle Scholar
  41. 41.
    Karabakhtsian RG, Johnson R, Sumkin J, Dabbs DJ. The clinical significance of lobular neoplasia on breast core biopsy. Am J Surg Pathol. 2007;31:717–23.PubMedCrossRefGoogle Scholar
  42. 42.
    Lavoue V, Graesslin O, Classe JM, et al. Management of lobular neoplasia diagnosed by core needle biopsy: study of 52 biopsies with follow-up surgical excision. Breast. 2007;16:533–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Margenthaler JA, Duke D, Monsees BS, et al. Correlation between core biopsy and excisional biopsy in breast high-risk lesions. Am J Surg. 2006;192:534–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Mahoney MC, Robinson-Smith TM, Shaughnessy EA. Lobular neoplasia at 11-gauge vacuum-assisted stereotactic biopsy: correlation with surgical excisional biopsy and mammographic follow-up. AJR Am J Roentgenol. 2006;187:949–54.PubMedCrossRefGoogle Scholar
  45. 45.
    Renshaw AA, Derhagopian RP, Martinez P, Gould EW. Lobular neoplasia in breast core needle biopsy specimens is associated with a low risk of ductal carcinoma in situ or invasive carcinoma on subsequent excision. Am J Clin Pathol. 2006;126:310–13.PubMedCrossRefGoogle Scholar
  46. 46.
    Elsheikh TM, Silverman JF. Follow-up surgical excision is indicated when breast core needle biopsies show atypical lobular hyperplasia or lobular carcinoma in situ: a correlative study of 33 patients with review of the literature. Am J Surg Pathol. 2005;29:534–43.PubMedCrossRefGoogle Scholar
  47. 47.
    Arpino G, Allred DC, Mohsin SK, et al. Lobular neoplasia on core-needle biopsy: clinical significance. Cancer. 2004;101:242–50.PubMedCrossRefGoogle Scholar
  48. 48.
    Foster MC, Helvie MA, Gregory NE, et al. Lobular carcinoma in situ or atypical lobular hyperplasia at core-needle biopsy: is excisional biopsy necessary? Radiology. 2004;231:813–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Bauer VP, Ditkoff BA, Schnabel F, et al. The management of lobular neoplasia identified on percutaneous core breast biopsy. Breast J. 2003;9: 4–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Crisi GM, Mandavilli S, Cronin E, Ricci A Jr. Invasive mammary carcinoma after immediate and short-term follow-up for lobular neoplasia on core biopsy. Am J Surg Pathol. 2003;27:325–33.PubMedCrossRefGoogle Scholar
  51. 51.
    Dmytrasz K, Tartter PI, Mizrachy H, et al. The significance of atypical lobular hyperplasia at percutaneous breast biopsy. Breast J. 2003;9:10–12.PubMedCrossRefGoogle Scholar
  52. 52.
    Middleton LP, Grant S, Stephens T, et al. Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised? Mod Pathol. 2003;16:120–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Irfan K, Brem RF. Surgical and mammographic follow-up of papillary lesions and atypical lobular hyperplasia diagnosed with stereotactic vacuum-assisted biopsy. Breast J. 2002;8:230–3.PubMedCrossRefGoogle Scholar
  54. 54.
    Renshaw AA, Cartagena N, Derhagopian RP, Gould EW. Lobular neoplasia in breast core needle biopsy specimens is not associated with an increased risk of ductal carcinoma in situ or invasive carcinoma. Am J Clin Pathol. 2002;117:797–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Shin SJ, Rosen PP. Excisional biopsy should be performed if lobular carcinoma in situ is seen on needle core biopsy. Arch Pathol Lab Med. 2002;126:697–701.Google Scholar
  56. 56.
    Berg WA, Mrose HE, Ioffe OB. Atypical lobular hyperplasia or lobular carcinoma in situ at core-needle breast biopsy. Radiology. 2001;218:503–9.PubMedCrossRefGoogle Scholar
  57. 57.
    O’Driscoll D, Britton P, Bobrow L, et al. Lobular carcinoma in situ on core biopsy-what is the clinical significance? Clin Radiol. 2001;56:216–20.PubMedCrossRefGoogle Scholar
  58. 58.
    Philpotts LE, Shaheen NA, Jain KS, et al. Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology. 2000;216:831–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Liberman L, Sama M, Susnik B, et al. Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings. AJR Am J Roentgenol. 1999;173:291–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Nakhlis F, Gilmore L, Gelman R, et al. Incidence of adjacent synchronous invasive carcinoma and/or ductal carcinoma in situ in patients with lobular neoplasia on core biopsy: results from a prospective multi-institutional registry (TBCRC 020). Ann Surg Oncol. 2016;23:722–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Middleton LP, Sneige N, Coyne R, et al. Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting. Cancer Med. 2014;3:492–9.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    National Cancer Center Network. NCCN Guidelines, Version 1.2016–Breast Cancer Screening and Diagnosis (2016). Retrieved 14 March 2017 at
  63. 63.
    Morrow M, Schnitt SJ, Norton L. Current management of lesions associated with an increased risk of breast cancer. Nat Rev Clin Oncol. 2015;12:227–38.PubMedCrossRefGoogle Scholar
  64. 64.
    D’Alfonso TM, Wang K, Chiu YL, Shin SJ. Pathologic upgrade rates on subsequent excision when lobular carcinoma in situ is the primary diagnosis in the needle core biopsy with special attention to the radiographic target. Arch Pathol Lab Med. 2013;137:927–35.PubMedCrossRefGoogle Scholar
  65. 65.
    Wazir U, Wazir A, Wells C, Mokbel K. Pleomorphic lobular carcinoma in situ: current evidence and a systemic review. Oncol Lett. 2016;12:4863–8.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Chivukula M, Haynik DM, Brufsky A, et al. Pleomorphic lobular carcinoma in situ (PLCIS) on breast core needle biopsies: clinical significance and immunoprofile. Am J Surg Pathol. 2008;32:1721–6.PubMedCrossRefGoogle Scholar
  67. 67.
    Flanagan MR, Rendi MH, Calhoun KE, et al. Pleomorphic lobular carcinoma in situ: radiologic-pathologic features and clinical management. Ann Surg Oncol. 2015;22:4263–9.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Carder PJ, Shaaban A, Alizadeh Y, et al. Screen-detected pleomorphic lobular carcinoma in situ (PLCIS): risk of concurrent invasive malignancy following a core biopsy diagnosis. Histopathology. 2010;57:472–8.PubMedCrossRefGoogle Scholar
  69. 69.
    Bagaria SP, Shamonki J, Kinnaird M, et al. The florid subtype of lobular carcinoma in situ: marker or precursor for invasive lobular carcinoma? Ann Surg Oncol. 2011;18:1845–51.PubMedCrossRefGoogle Scholar
  70. 70.
    Alvarado-Cabrero I, Picon Coronel G, Valencia Cedillo R, et al. Florid lobular intraepithelial neoplasia with signet ring cells, central necrosis and calcifications: a clinicopathological and immunohistochemical analysis of ten cases associated with invasive lobular carcinoma. Arch Med Res. 2010;41:436–41.PubMedCrossRefGoogle Scholar
  71. 71.
    McGhan LJ, Pockaj BA, Wasif N, et al. Atypical ductal hyperplasia on core biopsy: an automatic trigger for excisional biopsy? Ann Surg Oncol. 2012;19:3264–9.PubMedCrossRefGoogle Scholar
  72. 72.
    Pearlman MD, Griffin JL. Benign breast disease. Obstet Gynecol. 2010;116:747–58.PubMedCrossRefGoogle Scholar
  73. 73.
    Jackman RJ, Birdwell RL, Ikeda DM. Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision? Radiology. 2002;224:548–54.PubMedCrossRefGoogle Scholar
  74. 74.
    Winchester DJ, Bernstein JR, Jeske JM, et al. Upstaging of atypical ductal hyperplasia after vacuum-assisted 11-gauge stereotactic core needle biopsy. Arch Surg. 2003;138:619–22; discussion 622–3.Google Scholar
  75. 75.
    Sohn V, Arthurs Z, Herbert G, et al. Atypical ductal hyperplasia: improved accuracy with the 11-gauge vacuum-assisted versus the 14-gauge core biopsy needle. Ann Surg Oncol. 2007;14:2497–501.PubMedCrossRefGoogle Scholar
  76. 76.
    Burak WE Jr, Owens KE, Tighe MB, et al. Vacuum-assisted stereotactic breast biopsy: histologic underestimation of malignant lesions. Arch Surg. 2000;135:700–3.PubMedCrossRefGoogle Scholar
  77. 77.
    Deshaies I, Provencher L, Jacob S, et al. Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy. Breast. 2011;20:50–5.PubMedCrossRefGoogle Scholar
  78. 78.
    Rizzo M, Lund MJ, Oprea G, et al. Surgical follow-up and clinical presentation of 142 breast papillary lesions diagnosed by ultrasound-guided core-needle biopsy. Ann Surg Oncol. 2008;15:1040–7.PubMedCrossRefGoogle Scholar
  79. 79.
    Gendler LS, Feldman SM, Balassanian R, et al. Association of breast cancer with papillary lesions identified at percutaneous image-guided breast biopsy. Am J Surg. 2004;188:365–70.PubMedCrossRefGoogle Scholar
  80. 80.
    Valdes EK, Tartter PI, Genelus-Dominique E, et al. Significance of papillary lesions at percutaneous breast biopsy. Ann Surg Oncol. 2006;13:480–2.PubMedCrossRefGoogle Scholar
  81. 81.
    Renshaw AA, Derhagopian RP, Tizol-Blanco DM, Gould EW. Papillomas and atypical papillomas in breast core needle biopsy specimens: risk of carcinoma in subsequent excision. Am J Clin Pathol. 2004;122:217–21.PubMedCrossRefGoogle Scholar
  82. 82.
    Sohn V, Porta R, Brown T. Flat epithelial atypia of the breast on core needle biopsy: an indication for surgical excision. Mil Med. 2011;176:1347–50.PubMedCrossRefGoogle Scholar
  83. 83.
    Lavoue V, Roger CM, Poilblanc M, et al. Pure flat epithelial atypia (DIN 1a) on core needle biopsy: study of 60 biopsies with follow-up surgical excision. Breast Cancer Res Treat. 2011;125:121–6.PubMedCrossRefGoogle Scholar
  84. 84.
    Chivukula M, Bhargava R, Tseng G, Dabbs DJ. Clinicopathologic implications of “flat epithelial atypia” in core needle biopsy specimens of the breast. Am J Clin Pathol. 2009;131:802–8.PubMedCrossRefGoogle Scholar
  85. 85.
    Nguyen CV, Albarracin CT, Whitman GJ, et al. Atypical ductal hyperplasia in directional vacuum-assisted biopsy of breast microcalcifications: considerations for surgical excision. Ann Surg Oncol. 2011;18:752–61.PubMedCrossRefGoogle Scholar
  86. 86.
    Ko E, Han W, Lee JW, et al. Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy. Breast Cancer Res Treat. 2008;112:189–95.PubMedCrossRefGoogle Scholar
  87. 87.
    Pena A, Shah SS, Fazzio RT, et al. Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia. Breast Cancer Res Treat. 2017;164(2):295–304.PubMedCrossRefGoogle Scholar
  88. 88.
    Wagoner MJ, Laronga C, Acs G. Extent and histologic pattern of atypical ductal hyperplasia present on core needle biopsy specimens of the breast can predict ductal carcinoma in situ in subsequent excision. Am J Clin Pathol. 2009;131:112–21.PubMedCrossRefGoogle Scholar
  89. 89.
    Forgeard C, Benchaib M, Guerin N, et al. Is surgical biopsy mandatory in case of atypical ductal hyperplasia on 11-gauge core needle biopsy? A retrospective study of 300 patients. Am J Surg. 2008;196:339–45.PubMedCrossRefGoogle Scholar
  90. 90.
    Allison KH, Eby PR, Kohr J, et al. Atypical ductal hyperplasia on vacuum-assisted breast biopsy: suspicion for ductal carcinoma in situ can stratify patients at high risk for upgrade. Hum Pathol. 2011;42:41–50.PubMedCrossRefGoogle Scholar
  91. 91.
    Sneige N, Lim SC, Whitman GJ, et al. Atypical ductal hyperplasia diagnosis by directional vacuum-assisted stereotactic biopsy of breast microcalcifications: considerations for surgical excision. Am J Clin Pathol. 2003;119:248–53.PubMedCrossRefGoogle Scholar
  92. 92.
    Kohr JR, Eby PR, Allison KH, et al. Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. Radiology. 2010;255:723–30.PubMedCrossRefGoogle Scholar
  93. 93.
    Yeh IT, Dimitrov D, Otto P, et al. Pathologic review of atypical hyperplasia identified by image-guided breast needle core biopsy: correlation with excision specimen. Arch Pathol Lab Med. 2003;127:49–54.PubMedGoogle Scholar
  94. 94.
    Menes TS, Kerlikowske K, Lange J, et al. Subsequent breast cancer risk following diagnosis of atypical ductal hyperplasia on needle biopsy. JAMA Oncol. 2017;3:36–41.PubMedCrossRefGoogle Scholar
  95. 95.
    Menen RS, Ganesan N, Bevers T, et al. Long-term safety of observation in selected women following core biopsy diagnosis of atypical ductal hyperplasia. Ann Surg Oncol. 2017;24:70–6.PubMedCrossRefGoogle Scholar
  96. 96.
    Pankratz VS, Hartmann LC, Degnim AC, et al. Assessment of the accuracy of the Gail model in women with atypical hyperplasia. J Clin Oncol. 2008;26:5374–9.PubMedPubMedCentralCrossRefGoogle Scholar
  97. 97.
    Hartmann LC, Degnim AC, Santen RJ, et al. Atypical hyperplasia of the breast: risk assessment and management options. N Engl J Med. 2015;372:78–89.PubMedPubMedCentralCrossRefGoogle Scholar
  98. 98.
    Degnim AC, Visscher DW, Berman HK, et al. Stratification of breast cancer risk in women with atypia: a Mayo cohort study. J Clin Oncol. 2007;25:2671–7.PubMedCrossRefGoogle Scholar
  99. 99.
    Hartmann LC, Radisky DC, Frost MH, et al. Understanding the premalignant potential of atypical hyperplasia through its natural history: a longitudinal cohort study. Cancer Prev Res. 2014;7:211–7.CrossRefGoogle Scholar
  100. 100.
    Collins LC, Aroner SA, Connolly JL, et al. Breast cancer risk by extent and type of atypical hyperplasia: an update from the Nurses’ Health Studies. Cancer. 2016;122:515–20.PubMedCrossRefGoogle Scholar
  101. 101.
    American College of Radiology (2013). Practice parameter for the performance of contrast-enhanced magnetic resonance imaging (MRI) of the breast. Retrieved 14 May 2017 at
  102. 102.
    Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371–88.PubMedCrossRefGoogle Scholar
  103. 103.
    Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst. 2005;97:1652–62.PubMedCrossRefGoogle Scholar
  104. 104.
    Cuzick J, Warwick J, Pinney E, et al. Tamoxifen-induced reduction in mammographic density and breast cancer risk reduction: a nested case–control study. J Natl Cancer Inst. 2011;103:744–52.PubMedCrossRefGoogle Scholar
  105. 105.
    Goss PE, Ingle JN, Ales-Martinez JE, et al. Exemestane for breast cancer prevention in postmenopausal women. N Engl J Med. 2011;364:2381–91.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Jennifer M. Racz
    • 1
  • Jodi M. Carter
    • 1
  • Amy C. Degnim
    • 1
  1. 1.Mayo ClinicRochesterUSA

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