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Factors Predicting Breast Cancer Development in Women During Surveillance After Surgery for Atypical Ductal Hyperplasia of the Breast: Analysis of Clinical, Radiologic, and Histopathologic Features

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

Abstract

Background

This study aimed to evaluate the risk of breast cancer development for women under surveillance after surgery for atypical ductal hyperplasia (ADH), as well as the clinical and pathologic factors associated with breast cancer development.

Methods

From November 2003 to December 2014, the study included 205 women (mean age, 47.1 ± 11.2 years; range 18–73 years) with a pathologic diagnosis of ADH at surgical excision who had preoperative mammography and ultrasonography (US) images and pathology slides available for review. The patients were classified into three groups according to the detection method as follows: negative group (with ADH occult on imaging), mammography group (with ADH detected on mammography), and US group (with ADH detected on US only). Clinical, radiologic, and histopathologic factors associated with breast cancer development after ADH surgery were evaluated.

Results

Breast cancer developed in 15 patients (7.3%) during surveillance after ADH surgery (follow-up period, 63.9 ± 40.8 months). Palpable lesions had significantly higher rates of breast cancer development after ADH surgery (26.7% vs 6.8%; P = 0.045). Breast cancer development after ADH surgery did not differ according to the detection method (P = 0.654). Palpability was significantly associated with breast cancer development during surveillance after ADH surgery (hazard ratio, 3.579; 95% confidence interval 1.048–12.220; P = 0.042).

Conclusion

The breast cancer development rate for women under surveillance after ADH surgery was 7.3%. Palpability at the time of ADH diagnosis was significantly associated with breast cancer development.

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References

  1. 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 Philadelphia. 2014;7:211–7.

    Article  CAS  Google Scholar 

  2. Donaldson AR, McCarthy C, Goraya S, et al. Breast cancer risk associated with atypical hyperplasia and lobular carcinoma in situ initially diagnosed on core-needle biopsy. Cancer. 2018;124:459–65.

    Article  Google Scholar 

  3. Co M, Kwong A, Shek T. Factors affecting the under-diagnosis of atypical ductal hyperplasia diagnosed by core needle biopsies: a 10-year retrospective study and review of the literature. Int J Surg. 2018;49:27–31.

    Article  Google Scholar 

  4. Racz JM, Degnim AC. When does atypical ductal hyperplasia require surgical excision? Surg Oncol Clin N Am. 2018;27:23–32.

    Article  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. Visscher DW, Frost MH, Hartmann LC, et al. Clinicopathologic features of breast cancers that develop in women with previous benign breast disease. Cancer. 2016;122:378–85.

    Article  Google Scholar 

  8. Menes TS, Kerlikowske K, Lange J, Jaffer S, Rosenberg R, Miglioretti DL. Subsequent breast cancer risk following diagnosis of atypical ductal hyperplasia on needle biopsy. JAMA Oncol. 2017;3:36–41.

    Article  Google Scholar 

  9. Howard-McNatt M. Atypical ductal hyperplasia: what is the current risk for developing breast cancer? JAMA Oncol. 2017;3:20–1.

    Article  Google Scholar 

  10. Hartmann LC, Degnim AC, Dupont WD. Atypical hyperplasia of the breast. N Engl J Med. 2015;372:1271–2.

    PubMed  Google Scholar 

  11. American College of Radiology. Breast imaging reporting and data system, 5th ed. American College of Radiology, Reston, VA, 2013.

    Google Scholar 

  12. Park JW, Ko KH, Kim EK, Kuzmiak CM, Jung HK. Non-mass breast lesions on ultrasound: final outcomes and predictors of malignancy. Acta Radiol. 2017;58:1054–60.

    Article  Google Scholar 

  13. Ko KH, Hsu HH, Yu JC, et al. Non-mass-like breast lesions at ultrasonography: feature analysis and BI-RADS assessment. Eur J Radiol. 2015;84:77–85.

    Article  Google Scholar 

  14. Uematsu T. Non-mass-like lesions on breast ultrasonography: a systematic review. Breast Cancer. 2012;19:295–301.

    Article  Google Scholar 

  15. 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.

    Article  CAS  Google Scholar 

  16. Nguyen CV, Albarracin CT, Whitman GJ, Lopez A, Sneige N. Atypical ductal hyperplasia in directional vacuum-assisted biopsy of breast microcalcifications: considerations for surgical excision. Ann Surg Oncol. 2011;18:752–61.

    Article  Google Scholar 

  17. Thomas PS. Diagnosis and management of high-risk breast lesions. J Natl Compr Canc Netw. 2018;16:1391–6.

    Article  Google Scholar 

  18. Vierkant RA, Degnim AC, Radisky DC, et al. Mammographic breast density and risk of breast cancer in women with atypical hyperplasia: an observational cohort study from the Mayo Clinic Benign Breast Disease (BBD) cohort. BMC Cancer. 2017;17:84.

    Article  Google Scholar 

  19. 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;164:295–304.

    Article  CAS  Google Scholar 

  20. Uzan C, Mazouni C, Ferchiou M, et al. A model to predict the risk of upgrade to malignancy at surgery in atypical breast lesions discovered on percutaneous biopsy specimens. Ann Surg Oncol. 2013;20:2850–7.

    Article  Google Scholar 

  21. Gomes DS, Porto SS, Balabram D, Gobbi H. Inter-observer variability between general pathologists and a specialist in breast pathology in the diagnosis of lobular neoplasia, columnar cell lesions, atypical ductal hyperplasia, and ductal carcinoma in situ of the breast. Diagn Pathol. 2014;9:121.

    Article  Google Scholar 

  22. Jain RK, Mehta R, Dimitrov R, et al. Atypical ductal hyperplasia: interobserver and intraobserver variability. Mod Pathol. 2011;24:917–23.

    Article  Google Scholar 

  23. 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.

    Article  CAS  Google Scholar 

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Acknowledgments

This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) by the Ministry of Education (2018R1D1A1B07049378). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea

    Jung Hyun Yoon MD, PhD, Eun-Kyung Kim MD, PhD, Min Jung Kim MD, PhD, Vivian Youngjean Park MD, PhD & Hee Jung Moon MD, PhD

  2. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

    Ja Seung Koo MD, PhD

  3. Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea

    Hye Sun Lee PhD

Authors
  1. Jung Hyun Yoon MD, PhD
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  2. Ja Seung Koo MD, PhD
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  4. Eun-Kyung Kim MD, PhD
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  5. Min Jung Kim MD, PhD
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  6. Vivian Youngjean Park MD, PhD
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Correspondence to Hee Jung Moon MD, PhD.

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Yoon, J.H., Koo, J.S., Lee, H.S. et al. Factors Predicting Breast Cancer Development in Women During Surveillance After Surgery for Atypical Ductal Hyperplasia of the Breast: Analysis of Clinical, Radiologic, and Histopathologic Features. Ann Surg Oncol 27, 3614–3622 (2020). https://doi.org/10.1245/s10434-020-08476-9

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  • DOI: https://doi.org/10.1245/s10434-020-08476-9

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