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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

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.
Consecutive patients who underwent core biopsy which revealed ADH that underwent surgical excision.
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.
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.
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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