1. Determination of Factors Associated with Upstage in Atypical Ductal Hyperplasia to Identify Low-Risk Patients Where Active Surveillance May be an Alternative.
- Author
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Greene, Alexandra, Davis, Joshua, Moon, Jessica, Dubin, Iram, Cruz, Anastasia, Gupta, Megha, Moazzez, Ashkan, Ozao-Choy, Junko, Gupta, Esha, Manchandia, Tejas, Kalantari, Babak, Rahbar, Guita, and Dauphine, Christine
- Subjects
Atypical ductal hyperplasia (ADH) ,Low-risk cohort ,Predictors of upstage ,Female ,Humans ,Biopsy ,Large-Core Needle ,Breast ,Breast Neoplasms ,Calcinosis ,Carcinoma ,Ductal ,Breast ,Carcinoma ,Intraductal ,Noninfiltrating ,Cross-Sectional Studies ,Hyperplasia ,Mammography ,Retrospective Studies ,Watchful Waiting - Abstract
BACKGROUND: Excision is routinely recommended for atypical ductal hyperplasia (ADH) found on core biopsy given cancer upstage rates of near 20%. Identifying a cohort at low-risk for upstage may avoid low-value surgery. Objectives were to elucidate factors predictive of upstage in ADH, specifically near-complete core sampling, to potentially define a group at low upstage risk. PATIENTS AND METHODS: This retrospective, cross-sectional, multi-institutional study from 2015 to 2019 of 221 ADH lesions in 216 patients who underwent excision or active observation (≥ 12 months imaging surveillance, mean follow-up 32.6 months) evaluated clinical, radiologic, pathologic, and procedural factors for association with upstage. Radiologists prospectively examined imaging for lesional size and sampling proportion. RESULTS: Upstage occurred in 37 (16.7%) lesions, 25 (67.6%) to ductal carcinoma in situ (DCIS) and 12 (32.4%) to invasive cancer. Factors independently predictive of upstage were lesion size ≥ 10 mm (OR 5.47, 95% CI 2.03-14.77, p < 0.001), pathologic suspicion for DCIS (OR 12.29, 95% CI 3.24-46.56, p < 0.001), and calcification distribution pattern (OR 8.08, 95% CI 2.04-32.00, p = 0.003, regional; OR 19.28, 95% CI 3.47-106.97, p < 0.001, linear). Near-complete sampling was not correlated with upstage (p = 0.64). All three significant predictors were absent in 65 (29.4%) cases, with a 1.5% upstage rate. CONCLUSIONS: The upstage rate among 221 ADH lesions was 16.7%, highest in lesions ≥ 10 mm, with pathologic suspicion of DCIS, and linear/regional calcifications on mammography. Conversely, 30% of the cohort exhibited all low-risk factors, with an upstage rate < 2%, suggesting that active surveillance may be permissible in lieu of surgery.
- Published
- 2024