Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

• 影响指数: 3.992
• 发表时间: Jun 2021 19
• 来源期刊: Diagnostics (Basel)
• DOI: 10.3390/diagnostics11061120
• PMID: 34205428
• 文章类型: Journal Article
• 作者列表: Nicosia L,Latronico A,Addante F,De Santis R,Bozzini AC,Montesano M,Frassoni S,Bagnardi V,Mazzarol G,Pala O,Lazzeroni M,Lissidini G,Mastropasqua MG,Cassano E

关键词: BIRADS; atypical duct hyperplasia; breast biopsy; breast cancer; breast surgery; overtreatment; upgrade to cancer

Abstract

(1) Background: to evaluate which factors can reduce the upgrade rate of atypical ductal hyperplasia (ADH) to in situ or invasive carcinoma in patients who underwent vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. (2) Methods: 2955 VABBs were reviewed; 141 patients with a diagnosis of ADH were selected for subsequent surgical excision. The association between patients\' characteristics and the upgrade rate to breast cancer was evaluated in both univariate and multivariate analyses. (3) Results: the upgrade rates to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) were, respectively, 29.1% and 7.8%. The pooled upgrade rate to DCIS or IC was statistically lower at univariate analysis, considering the following parameters: complete removal of the lesion (p-value < 0.001); BIRADS ≤ 4a (p-value < 0.001); size of the lesion ≤15 mm (p-value: 0.002); age of the patients <50 years (p-value: 0.035). (4) Conclusions: the overall upgrade rate of ADH to DCIS or IC is high and, as already known, surgery should be recommended. However, ADH cases should always be discussed in multidisciplinary meetings: some parameters appear to be related to a lower upgrade rate. Patients presenting these parameters could be strictly followed up to avoid overtreatment.