Development and Prospective Validation of a Risk Calculator That Predicts a Low Risk Cohort for Atypical Ductal Hyperpla
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ORIGINAL ARTICLE – BREAST ONCOLOGY
Development and Prospective Validation of a Risk Calculator That Predicts a Low Risk Cohort for Atypical Ductal Hyperplasia Upstaging to Malignancy: Evidence for a Watch and Wait Strategy of a High-Risk Lesion Daniel Ben Lustig, MSc, MD1,2, Michael Guo, MD2, Claire Liu, MD2, Rebecca Warburton, MD, FRCSC2,3, Carol K. Dingee, MSc, MD, FRCSC2,3, Jin-Si Pao, MD, FRCSC2,3, Urve Kuusk, MD, FRCSC2,3, Leo Chen, MSc2, and Elaine C. McKevitt, MEd, MD, FRCSC2,3 1
Department of Surgery, Vancouver Coastal Health, Vancouver, BC, Canada; 2University of British Columbia, Vancouver, Canada; 3Providence Health Care, Vancouver, Canada
ABSTRACT Background. Guidelines recommend surgical excision of atypical ductal hyperplasia (ADH) due to the concern of undersampling a potential malignancy on core needle biopsy (CNB). The purpose of this study was to determine clinical, radiological and pathological variables associated with ADH upstaging to cancer and to develop a predictive risk calculator capable of identifying women who have a low oncological risk of upstaging. Methods. A prospectively collected database from a tertiary breast referral center was analyzed for women diagnosed with ADH on CNB between January 2013 to December 2017 who underwent surgical excision. CNB and surgical pathology reports were examined to determine rate of upstaging. The association between clinical, radiological and pathological variables were evaluated using regression analysis to determine predictors of ADH upstaging to cancer. Significant variables (p B 0.05) identified on univariate analysis were assigned a score of
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08881-0) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 28 February 2020 Accepted: 4 May 2020 D. B. Lustig, MSc, MD e-mail: [email protected]
‘‘1’’ and were included in the ADH upstaging risk calculator. Results. A total of 1986 patients underwent surgery for a high-risk lesion. We identified 318 (16.0%) patients who had ADH identified on their CNB who underwent surgery—of which 290 were included in our study. The upstage rate was 24.8%. Five variables were associated with upstaging and included in our calculator: (1) lesion [ 5 mm on ultrasound; (2) lesion [ 5 mm on mammogram; (3) one or more ‘‘high-risk’’ lesion(s) on CNB; (4) pathological suspicion for cancer and; (5) incomplete removal of calcifications on CNB. Patients with a score of 0 had a 2% risk of being upstaged to cancer and were deemed low risk with 17.2% of patients falling within this category. Conclusions. Patients with ADH on CNB can be stratified into a low oncological cohort who have a 2% risk of being upstaged to carcinoma. In the future, these select patients may be counselled and potentially offered observation as an alternative to surgery. Keywords Atypical ductal hyperplasia Breast cancer Risk calculator Benign breast disease Predic
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