caa a22 4500 445335033 CHVBK 20180317142751.0 cr unu---uuuuu 170323e20110301xx s 000 0 eng 10.1245/s10434-010-1127-8 doi (NATIONALLICENCE)springer-10.1245/s10434-010-1127-8 Atypical Ductal Hyperplasia in Directional Vacuum-Assisted Biopsy of Breast Microcalcifications: Considerations for Surgical Excision [Elektronische Daten] [Christopher Nguyen, Constance Albarracin, Gary Whitman, Adriana Lopez, Nour Sneige] 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. Materials and Methods: We retrospectively evaluated the clinical, mammographic, and histologic features of 140 patients with DVAB-diagnosed ADH who underwent either segmental excision (86.4%) or mammographic follow-up (≥2years; 13.6%). Cases with mass lesions or ipsilateral cancer were excluded. Results: In 16 cases, carcinoma was found on excision. All cases without excision showed no new abnormalities on mammographic follow-up. Only the amount of calcifications removed (≤95%) significantly correlated with the rate of upgrade of ADH to carcinoma (P=.037). Significant histologic predictors of upgrade to carcinoma included number of terminal duct-lobular units (TDLU; >2) involved (P=.0306), presence of significant cytologic atypia suspicious for intermediate or high-grade carcinoma (P<.0001), and necrosis (P=.0006). Among ADH cases without significant atypia and/or necrosis, the extent of ADH (≤2 vs. >2 TDLU involved) was not a significant predictor of carcinoma (P=1.0000). Conclusions: ADH associated with calcifications in the absence of a mass lesion can be categorized into different risk groups using a multidisciplinary approach with correlation of histologic and mammographic findings. ADH lesions with significant cytologic atypia and/or necrosis are most likely to be associated with carcinoma and should be excised. ADH without these features, regardless of extent of involvement, and with >95% removal of the targeted calcifications, is associated with a minimal risk (<3%) of carcinoma and may undergo mammographic follow-up only. Society of Surgical Oncology, 2010 Nguyen Christopher Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA aut Albarracin Constance Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA aut Whitman Gary Department of Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA aut Lopez Adriana Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA aut Sneige Nour Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA aut Annals of Surgical Oncology Springer-Verlag 18/3(2011-03-01), 752-761 1068-9265 18:3<752 2011 18 10434 https://doi.org/10.1245/s10434-010-1127-8 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-010-1127-8 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Nguyen Christopher Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA aut NATIONALLICENCE 700 1- Albarracin Constance Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA aut NATIONALLICENCE 700 1- Whitman Gary Department of Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA aut NATIONALLICENCE 700 1- Lopez Adriana Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA aut NATIONALLICENCE 700 1- Sneige Nour Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/3(2011-03-01), 752-761 1068-9265 18:3<752 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer