Atypical ductal hyperplasia and the risk of underestimation: tissue sampling method, multifocality, and associated calci
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ORIGINAL ARTICLE
Atypical ductal hyperplasia and the risk of underestimation: tissue sampling method, multifocality, and associated calcification significantly influence the diagnostic upgrade rate based on subsequent surgical specimens Christoph J. Rageth1,2,6 · Ravit Rubenov2 · Cristian Bronz3 · Daniel Dietrich4 · Christoph Tausch2 · Ann‑Katrin Rodewald5 · Zsuzsanna Varga5 Received: 4 July 2018 / Accepted: 18 December 2018 © The Author(s) 2018
Abstract Background Risk assessment and therapeutic options are challenges when counselling patients with an atypical ductal hyperplasia (ADH) to undergo either open surgery or follow-up only. Methods We retrospectively analyzed a series of ADH lesions and assessed whether the morphological parameters of the biopsy materials indicated whether the patient should undergo surgery. A total of 207 breast biopsies [56 core needle biopsies (CNBs) and 151 vacuum-assisted biopsies (VABs)] histologically diagnosed as ADH were analyzed retrospectively, together with subsequently obtained surgical specimens. All histological slides were re-analyzed with regard to the presence/ absence of ADH-associated calcification, other B3 lesions (lesion of uncertain malignant potential), extent of the lesion, and the presence of multifocality. Results The overall underestimation rate for the whole cohort was 39% (57% for CNB, 33% for VAB). In the univariate analysis, the method of biopsy (CNB vs VAB, p = 0.002) and presence of multifocality in VAB specimens (p = 0.0176) were significant risk factors for the underestimation of the disease (ductal carcinoma in situ or invasive cancer detected on subsequent open biopsy). In the multivariate logistic regression model, the absence of calcification (p = 0.0252) and the presence of multifocality (unifocal vs multifocal ADH, p = 0.0147) in VAB specimens were significant risk factors for underestimation. Conclusions Multifocal ADH without associated calcification diagnosed by CNB tends to have a higher upgrade rate. Because the upgrade rate was 16.5% even in the group with the lowest risk (VAB-diagnosed unifocal ADH with calcification), we could not identify a subgroup that would not require an open biopsy. Keywords B3 lesion · Atypical ductal hyperplasia · ADH · Underestimation
* Christoph J. Rageth [email protected] 1
Centre du sein, Département de Gynécologie et d’Obstétrique, Hôpitaux Universitaires de Genève, Bd de la Cluse 30, 1211 Geneva 14, Switzerland
2
Brust-Zentrum Zürich, Seefeldstr. 214, 8008 Zurich, Switzerland
3
Clinic for Gynecology, University Hospital Zurich, 8091 Zurich, Switzerland
4
Swiss Group for Clinical Cancer Research, Bern, Switzerland
5
Institute of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
6
Ringlikerstrasse 53, 8142 Uitikon Waldegg, Switzerland
Introduction Atypical ductal hyperplasia (ADH) is a small, mostly unifocal, low-grade intraductal lesion in the breast, which in most cases is detected by the associated calcification seen on m
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