Underestimation of cancer in case of diagnosis of atypical ductal hyperplasia (ADH) by vacuum assisted core needle biopsy

Abstract

Background: With the introduction of mammography screening, we are more often dealing with the diagnosis of precancerous and preinvasive breast lesions. An increasing number of patients are observed to show a premalignant change of ADH (atypical ductal hyperplasia). It also involves a wider use of the vacuum assisted core biopsy as a tool for verifying nonpalpable changes identified by mammography.

Aim: This paper describes our experience of 134 cases of ADH diagnosed at Mammotome(®) vacuum core needle biopsy.

Material and methods: Of 4326 mammotomic biopsies performed at our institution in 2000-2006, ADH was diagnosed in 134 patients (3.1%). Patients underwent surgery to remove the suspected lesion. All histopathological blocks were again reviewed by one pathologist. Clinical, radiological and pathological data were collected for statistical evaluation.

Results: Underestimation of invasive changes occurred in 12 patients (9%). The only clinicopathologic feature of statistical significance radiologically and pathologically was the presence of radial scar in the mammography.

Conclusions: More frequent diagnosis of precancerous changes in the mammotomic breast biopsy forces us to establish a clear clinical practice. The problem is the underestimation of invasive changes. The occurrence of radial scar on mammography for diagnosis of the presence of ADH increases the risk of invasive changes.

Keywords: Atypical ductal hyperplasia; Breast cancer; Core biopsy.