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2010 Annual Meeting Abstracts

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Large Needle Core Biopsy of Atypical Ductal Hyperplasia: Results of Surgical Excision
*Kuo-Hsiu Liao, *Prakash Pandalai, James D. Iglehart, *Parisa Lotfi, *Jack Meyer, *Jane Brock, *Mehra Golshan
Brigham and Women's Hospital, Boston, MA

Objective:
Atypical Ductal Hyperplasia (ADH) is a marker for increased risk of developing breast cancer. To determine the rate in which a diagnosis of ADH is upgraded to breast cancer after surgical excision.
Design:
Consecutive patients who underwent core biopsy which revealed ADH that underwent surgical excision.
Setting:
Between 2003 and 2007, 166 women underwent core biopsy that revealed ADH after review by the breast pathology service.
Patients: Women had core biopsy and subsequent surgical excision and pathology review performed at our institution.
Interventions: Surgical excision of ADH.
Main Outcome Measures:Rate of change to a diagnosis of breast cancer.
Results:
The mean age of 166 patients with ADH was 54.9. After surgical excision, 52 (31%) patients had a final diagnosis of DCIS or invasive breast cancer. DCIS was found in 39 (23%) women and invasive cancer in 13 (8%). Of these, 97% of the DCIS and 100% of the invasive cancers were low or intermediate grade. All patients were estrogen and or progesterone positive. Calcifications accounted for 87% (144) of the index lesions, 11% (22) presented with a mass, and the remainder as a density 2% (4) on mammography. 77% (129) underwent core biopsy with an 11 gauge device.
Conclusions:
A significant number of patients who present with ADH on core biopsy were found to have either non-invasive or invasive breast cancer after surgical biopsy. The majority of cancers were low/intermediate grade suggesting carcinomas associated with ADH on core biopsy are more likely associated with a progression pathway leading to low grade cancer. With the larger core biopsy devices available, the rate of upgrading the diagnosis to invasive breast cancer has not decreased.


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