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Constance D Lehman - One of the best experts on this subject based on the ideXlab platform.
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Atypical Ductal Hyperplasia on vacuum assisted breast biopsy suspicion for Ductal carcinoma in situ can stratify patients at high risk for upgrade
Human Pathology, 2011Co-Authors: Kimberly H Allison, Peter R Eby, Jennifer R Kohr, Wendy B Demartini, Constance D LehmanAbstract:Summary We evaluated 97 cases of review-confirmed Atypical Ductal Hyperplasia found on stereotactic vacuum-assisted breast biopsy of suspicious calcifications. The number and size of foci of Atypical Ductal Hyperplasia and presence of a micropapillary component were noted. In addition, we recorded if a case was considered "Atypical Ductal Hyperplasia suspicious for Ductal carcinoma in situ" using specific qualitative criteria. The upgrade rate was 20.6% (20/97) for all cases and 48% (12/25) for cases suspicious for Ductal carcinoma in situ. Suspicion for Ductal carcinoma in situ was found to be a strong predictor of upgrade with an odds ratio of 7.4 ( P = .0003). Suspicious cases with nuclear features bordering on intermediate nuclear grade had the highest upgrade rate of 75% (6/8). Cases with ≥3 foci had significantly higher upgrade rates (28%) than those with less than 3 foci (11%), but focal Atypical Ductal Hyperplasia did upgrade ( P = .04). In conclusion, qualitative features of Atypical Ductal Hyperplasia on core biopsy such as suspicion for Ductal carcinoma in situ may help stratify patients at the highest risk for upgrade.
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risk of upgrade of Atypical Ductal Hyperplasia after stereotactic breast biopsy effects of number of foci and complete removal of calcifications
Radiology, 2010Co-Authors: Jennifer R Kohr, Kimberly H Allison, Peter R Eby, Wendy B Demartini, Sue Peacock, Robert L Gutierrez, Constance D LehmanAbstract:Ultimately, despite the theoretically improved accuracy of 9- and 11-gauge vacuum-assisted breast biopsy needles and the risk stratification performed on the basis of histopathologic and mammographic criteria, we were unable to identify a subpopulation of patients with Atypical Ductal Hyperplasia who could safely avoid surgical excision.
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Is surgical excision necessary for focal Atypical Ductal Hyperplasia found at stereotactic vacuum-assisted breast biopsy?
Annals of Surgical Oncology, 2008Co-Authors: Peter R Eby, Kimberly H Allison, Wendy B Demartini, Jennifer E. Ochsner, Sue Peacock, Constance D LehmanAbstract:Background Our goal was to determine the upgrade rate for lesions described as focal Atypical Ductal Hyperplasia (ADH) after 9- or 11-gauge stereotactic vacuum-assisted breast biopsy (VABB) to determine whether surgical excision is indicated in this setting.
Peter R Eby - One of the best experts on this subject based on the ideXlab platform.
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Atypical Ductal Hyperplasia on vacuum assisted breast biopsy suspicion for Ductal carcinoma in situ can stratify patients at high risk for upgrade
Human Pathology, 2011Co-Authors: Kimberly H Allison, Peter R Eby, Jennifer R Kohr, Wendy B Demartini, Constance D LehmanAbstract:Summary We evaluated 97 cases of review-confirmed Atypical Ductal Hyperplasia found on stereotactic vacuum-assisted breast biopsy of suspicious calcifications. The number and size of foci of Atypical Ductal Hyperplasia and presence of a micropapillary component were noted. In addition, we recorded if a case was considered "Atypical Ductal Hyperplasia suspicious for Ductal carcinoma in situ" using specific qualitative criteria. The upgrade rate was 20.6% (20/97) for all cases and 48% (12/25) for cases suspicious for Ductal carcinoma in situ. Suspicion for Ductal carcinoma in situ was found to be a strong predictor of upgrade with an odds ratio of 7.4 ( P = .0003). Suspicious cases with nuclear features bordering on intermediate nuclear grade had the highest upgrade rate of 75% (6/8). Cases with ≥3 foci had significantly higher upgrade rates (28%) than those with less than 3 foci (11%), but focal Atypical Ductal Hyperplasia did upgrade ( P = .04). In conclusion, qualitative features of Atypical Ductal Hyperplasia on core biopsy such as suspicion for Ductal carcinoma in situ may help stratify patients at the highest risk for upgrade.
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risk of upgrade of Atypical Ductal Hyperplasia after stereotactic breast biopsy effects of number of foci and complete removal of calcifications
Radiology, 2010Co-Authors: Jennifer R Kohr, Kimberly H Allison, Peter R Eby, Wendy B Demartini, Sue Peacock, Robert L Gutierrez, Constance D LehmanAbstract:Ultimately, despite the theoretically improved accuracy of 9- and 11-gauge vacuum-assisted breast biopsy needles and the risk stratification performed on the basis of histopathologic and mammographic criteria, we were unable to identify a subpopulation of patients with Atypical Ductal Hyperplasia who could safely avoid surgical excision.
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Is surgical excision necessary for focal Atypical Ductal Hyperplasia found at stereotactic vacuum-assisted breast biopsy?
Annals of Surgical Oncology, 2008Co-Authors: Peter R Eby, Kimberly H Allison, Wendy B Demartini, Jennifer E. Ochsner, Sue Peacock, Constance D LehmanAbstract:Background Our goal was to determine the upgrade rate for lesions described as focal Atypical Ductal Hyperplasia (ADH) after 9- or 11-gauge stereotactic vacuum-assisted breast biopsy (VABB) to determine whether surgical excision is indicated in this setting.
Nour Sneige - One of the best experts on this subject based on the ideXlab platform.
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Atypical Ductal Hyperplasia in Directional Vacuum-Assisted Biopsy of Breast Microcalcifications: Considerations for Surgical Excision
Annals of Surgical Oncology, 2010Co-Authors: Christopher V. Nguyen, Constance Albarracin, Gary J. Whitman, Adriana Lopez, Nour SneigeAbstract:Background Our goal was to analyze clinicopathologic features of patients with Atypical Ductal Hyperplasia (ADH) diagnosed on directional vacuum-assisted biopsy (DVAB) targeting microcalcifications to identify factors predicting the presence of carcinoma.
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Atypical Ductal Hyperplasia Diagnosis by Directional Vacuum-Assisted Stereotactic Biopsy of Breast Microcalcifications
American journal of clinical pathology, 2003Co-Authors: Nour Sneige, Gary J. Whitman, Aysegul A. Sahin, Terry L. Smith, Sung C. Lim, Savitri Krishnamurthy, Carol B. StellingAbstract:In 824 patients who underwent directional vacuum-assisted biopsies (DVABs) of breast microcalcifications, 61 (7.4%) showed Atypical Ductal Hyperplasia (ADH). The 42 who subsequently underwent excision were the subjects of this study. Cases were evaluated for the mammographic characteristics of the lesion, the percentage of lesion removed according to mammography, and histologic findings (including number of large ducts and/or terminal duct–lobular units involved with ADH) in DVAB specimens. Pathologic findings in the surgical specimens in the area of the biopsy site also were recorded. In the DVAB specimens, ADH was confined to an average of 1.5 large ducts or lobular units and was associated with microcalcifications in all of the patients. Surgical specimens showed ADH in 15 cases, no residual lesion in 24 cases, and Ductal carcinoma in situ in 3 cases. We found that microcalcifications that contain ADH in less than 3 lobules or ducts and/or that are removed completely by DVAB do not reveal higher-risk lesions on excision; thus, removal is unnecessary. When assessing microcalcifications with ADH, clinicians should consider the percentage of microcalcifications removed by DVAB and the extent of lobular involvement to better assess the need for excision.
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Mucocelelike tumor of the breast associated with Atypical Ductal Hyperplasia or mucinous carcinoma. A clinicopathologic study of seven cases.
Archives of pathology & laboratory medicine, 1991Co-Authors: Nour Sneige, Aysegul A. Sahin, Elvio G. Silva, G. W. Del Junco, Alberto G. AyalaAbstract:We studied seven patients with mucocelelike tumors of the breast, known to be benign lesions that may be confused with mucinous carcinomas of the breast. All patients had a palpable mass. Microscopically, the most striking feature was the cystic character of the lesion. The epithelial lining of the cysts was usually flat or cuboidal to low columnar, and mucin pools frequently appeared near the ruptured cysts. Three mucocelelike tumors contained a microscopic focus of mucinous carcinoma. The other tumors had areas of Atypical Ductal Hyperplasia containing abundant intraluminal mucinous materials. The mucin was composed predominantly of neutral and nonsulfated acid mucins whose character was identical to that of those in mucinous carcinoma. Because all mucocelelike tumors in our series were associated with either Atypical Ductal Hyperplasia or carcinoma and because some mucocelelike tumors may indeed be early mucinous carcinomas of the breast, we recommend examination of the entire specimen and careful clinical follow-up.
Kimberly H Allison - One of the best experts on this subject based on the ideXlab platform.
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Atypical Ductal Hyperplasia on vacuum assisted breast biopsy suspicion for Ductal carcinoma in situ can stratify patients at high risk for upgrade
Human Pathology, 2011Co-Authors: Kimberly H Allison, Peter R Eby, Jennifer R Kohr, Wendy B Demartini, Constance D LehmanAbstract:Summary We evaluated 97 cases of review-confirmed Atypical Ductal Hyperplasia found on stereotactic vacuum-assisted breast biopsy of suspicious calcifications. The number and size of foci of Atypical Ductal Hyperplasia and presence of a micropapillary component were noted. In addition, we recorded if a case was considered "Atypical Ductal Hyperplasia suspicious for Ductal carcinoma in situ" using specific qualitative criteria. The upgrade rate was 20.6% (20/97) for all cases and 48% (12/25) for cases suspicious for Ductal carcinoma in situ. Suspicion for Ductal carcinoma in situ was found to be a strong predictor of upgrade with an odds ratio of 7.4 ( P = .0003). Suspicious cases with nuclear features bordering on intermediate nuclear grade had the highest upgrade rate of 75% (6/8). Cases with ≥3 foci had significantly higher upgrade rates (28%) than those with less than 3 foci (11%), but focal Atypical Ductal Hyperplasia did upgrade ( P = .04). In conclusion, qualitative features of Atypical Ductal Hyperplasia on core biopsy such as suspicion for Ductal carcinoma in situ may help stratify patients at the highest risk for upgrade.
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risk of upgrade of Atypical Ductal Hyperplasia after stereotactic breast biopsy effects of number of foci and complete removal of calcifications
Radiology, 2010Co-Authors: Jennifer R Kohr, Kimberly H Allison, Peter R Eby, Wendy B Demartini, Sue Peacock, Robert L Gutierrez, Constance D LehmanAbstract:Ultimately, despite the theoretically improved accuracy of 9- and 11-gauge vacuum-assisted breast biopsy needles and the risk stratification performed on the basis of histopathologic and mammographic criteria, we were unable to identify a subpopulation of patients with Atypical Ductal Hyperplasia who could safely avoid surgical excision.
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Is surgical excision necessary for focal Atypical Ductal Hyperplasia found at stereotactic vacuum-assisted breast biopsy?
Annals of Surgical Oncology, 2008Co-Authors: Peter R Eby, Kimberly H Allison, Wendy B Demartini, Jennifer E. Ochsner, Sue Peacock, Constance D LehmanAbstract:Background Our goal was to determine the upgrade rate for lesions described as focal Atypical Ductal Hyperplasia (ADH) after 9- or 11-gauge stereotactic vacuum-assisted breast biopsy (VABB) to determine whether surgical excision is indicated in this setting.
Francesco Sardanelli - One of the best experts on this subject based on the ideXlab platform.
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An update on the management of breast Atypical Ductal Hyperplasia
The British Journal of Radiology, 2020Co-Authors: Simone Schiaffino, Andrea Cozzi, Francesco SardanelliAbstract:Among lesions with uncertain malignant potential found at percutaneous breast biopsy, Atypical Ductal Hyperplasia (ADH) carries both the highest risk of underestimation and the closest and most pat...
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Upgrade Rate of Percutaneously Diagnosed Pure Atypical Ductal Hyperplasia: Systematic Review and Meta-Analysis of 6458 Lesions
Radiology, 2020Co-Authors: Simone Schiaffino, Andrea Cozzi, Massimo Calabrese, E. Melani, Rubina Manuela Trimboli, Luca A. Carbonaro, Giovanni Di Leo, Francesco SardanelliAbstract:Given the upgrade rate of Atypical Ductal Hyperplasia, management of these lesions with imaging follow-up is not advisable; surgical excision is preferred.
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An update on the management of breast Atypical Ductal Hyperplasia
'British Institute of Radiology', 2020Co-Authors: Simone Schiaffino, Andrea Cozzi, Francesco SardanelliAbstract:Among lesions with uncertain malignant potential found at percutaneous breast biopsy, Atypical Ductal Hyperplasia (ADH) carries both the highest risk of underestimation and the closest and most pathologist-dependent differential diagnosis with Ductal carcinoma in situ (DCIS), matching the latter's features save for size only. ADH is therefore routinely surgically excised, but single-centre studies with limited sample size found low rates of upgrade to invasive cancer or DCIS. This suggests the possibility of surveillance over surgery in selected subgroups, considering the 2% threshold allowing for follow-up according to the Breast Imaging Reporting and Data System. A recent meta-analysis on 6458 lesions counters this approach, confirming that, surgically excised or managed with surveillance, ADH carries a 29% and 5% upgrade rate, respectively, invariably higher than 2% even in subgroups considering biopsy guidance and technique, needle calibre, apparent complete lesion removal. The high heterogeneity (I2 = 80%) found in this meta-analysis reaffirmed the need to synthesize evidence from systematic reviews to achieve generalizable results, fit for guidelines development. Limited tissue sampling at percutaneous biopsy intrinsically hampers the prediction of ADH-associated malignancy. This prediction could be improved by using contrast-enhanced breast imaging and applying artificial intelligence on both pathology and imaging results, allowing for overtreatment reduction
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upgrade rate of percutaneously diagnosed pure Atypical Ductal Hyperplasia systematic review and meta analysis of 6458 lesions
Radiology, 2020Co-Authors: Simone Schiaffino, Andrea Cozzi, Massimo Calabrese, E. Melani, Rubina Manuela Trimboli, Luca A. Carbonaro, Giovanni Di Leo, Francesco SardanelliAbstract:Background Management of percutaneously diagnosed pure Atypical Ductal Hyperplasia (ADH) is an unresolved clinical issue. Purpose To calculate the pooled upgrade rate of percutaneously diagnosed pure ADH. Materials and Methods A search of MEDLINE and EMBASE databases was performed in October 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines were followed. A fixed- or random-effects model was used, along with subgroup and meta-regression analyses. The Newcastle-Ottawa scale was used for study quality, and the Egger test was used for publication bias. Results Of 521 articles, 93 were analyzed, providing data for 6458 ADHs (5911 were managed with surgical excision and 547 with follow-up). Twenty-four studies used core-needle biopsy; 44, vacuum-assisted biopsy; 21, both core-needle and vacuum-assisted biopsy; and four, unspecified techniques. Biopsy was performed with stereotactic guidance in 29 studies; with US guidance in nine, with MRI guidance in nine, and with mixed guidance in eight. Overall heterogeneity was high (I2 = 80%). Subgroup analysis according to management yielded a pooled upgrade rate of 29% (95% confidence interval [CI]: 26%, 32%) for surgically excised lesions and 5% (95% CI: 4%, 8%) for lesions managed with follow-up (P < .001). Heterogeneity was entirely associated with surgically excised lesions (I2 = 78%) rather than those managed with follow-up (I2 = 0%). Most variability was explained by guidance and needle caliper (P = .15). At subgroup analysis of surgically excised lesions, the pooled upgrade rate was 42% (95% CI: 31%, 53%) for US guidance, 23% (95% CI: 19%, 27%) for stereotactic biopsy, and 32% (95% CI: 22%, 43%) for MRI guidance, with heterogeneity (52%, 63%, and 56%, respectively) still showing the effect of needle caliper. When the authors considered patients with apparent complete lesion removal after biopsy (subgroups in 14 studies), the pooled upgrade rate was 14% (95% CI: 8%, 23%). Study quality was low to medium; the risk of publication bias was low (P = .10). Conclusion Because of a pooled upgrade rate higher than 2% (independent of biopsy technique, needle size, imaging guidance, and apparent complete lesion removal), Atypical Ductal Hyperplasia diagnosed with percutaneous needle biopsy should be managed with surgical excision. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Brem in this issue.
