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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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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 ≤ 0.05) identified on univariate analysis were assigned a score of “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.

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Authors and Affiliations

  1. Department of Surgery, Vancouver Coastal Health, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada

    Daniel Ben Lustig MSc, MD

  2. University of British Columbia, Vancouver, Canada

    Daniel Ben Lustig MSc, MD, Michael Guo MD, Claire Liu MD, Rebecca Warburton MD, FRCSC, Carol K. Dingee MSc, MD, FRCSC, Jin-Si Pao MD, FRCSC, Urve Kuusk MD, FRCSC, Leo Chen MSc & Elaine C. McKevitt MEd, MD, FRCSC

  3. Providence Health Care, Vancouver, Canada

    Rebecca Warburton MD, FRCSC, Carol K. Dingee MSc, MD, FRCSC, Jin-Si Pao MD, FRCSC, Urve Kuusk MD, FRCSC & Elaine C. McKevitt MEd, MD, FRCSC

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  1. Daniel Ben Lustig MSc, MD
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  2. Michael Guo MD
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  3. Claire Liu MD
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  4. Rebecca Warburton MD, FRCSC
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  5. Carol K. Dingee MSc, MD, FRCSC
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  8. Leo Chen MSc
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  9. Elaine C. McKevitt MEd, MD, FRCSC
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Correspondence to Daniel Ben Lustig MSc, MD.

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Lustig, D.B., Guo, M., Liu, C. et al. 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. Ann Surg Oncol 27, 4622–4627 (2020). https://doi.org/10.1245/s10434-020-08881-0

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  • DOI: https://doi.org/10.1245/s10434-020-08881-0

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