ASSOCIATION OF BREAST-CANCER WITH THE FINDING OF ATYPICAL DUCTAL HYPERPLASIA AT CORE BREAST BIOPSY

Objective The purpose of the study is to evaluate the prevalence of oc cult breast carcinoma in surgical breast biopsies performed on nonpalp able breast lesions diagnosed initially as atypical ductal hyperplasia (ADH) by core needle biopsy. Background Atypical ductal hyperplasia i s a lesion with significant malignant potential. Some authors note tha t ADH and ductal carcinoma in situ (DCIS) frequently coexist in the sa me lesion. The criterion for the diagnosis of DCIS requires involvemen t of at least two ducts; otherwise, a lesion that is qualitatively con sistent with DCIS but quantitatively insufficient is described as atyp ical ductal hyperplasia. Thus, the finding of ADH in a core needle bre ast biopsy specimen actually may represent a sample of a true in situ carcinoma, Methods Between May 3, 1994, and June 12, 1996, image-guide d core biopsies of 510 mammographically identified lesions were perfor med using a 14-gauge automated device with an average of 7.5 cores obt ained per lesion. Atypical ductal hyperplasia was found in 23 (4.5%) o f 510 lesions, and surgical excision subsequently was performed in 21 of these cases. In these 21 cases, histopathologic results from core n eedle and surgical biopsies were reviewed and correlated. Results Hist opathologic study of the 21 surgically excised lesions having ADH in t heir core needle specimens showed seven (33.3%) with DCIS. Conclusions In the authors' patient population, one third of patients with ADH at core biopsy have an occult carcinoma. A core needle breast biopsy fin ding of ADH for nonpalpable lesions therefore warrants a recommendatio n for excisional biopsy.