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Safety of de-escalation of surgical intervention for atypical ductal hyperplasia on percutaneous biopsy: One size does not fit all

Published:September 23, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.09.044

      Highlights

      • LOW comprises 21% of our ADH population.
      • LOW effectively identifies ADH at lowest risk for upgrade (0%).
      • 0% of LOW in AM developed a breast cancer at ADH site in follow up.

      Abstract

      Background

      Oncologic safety of active monitoring (AM) for atypical ductal hyperplasia (ADH) on core-needle biopsy (CNB) is not well defined. We sought to define oncologic outcomes for AM to manage ADH meeting institutional predefined low-risk criteria (LOW).

      Methods

      ADH was diagnosed on CNB from 10/2015-03/2020. LOW (pure ADH, size <1 cm, >50% removed by CNB, <3 foci, and no necrosis) patients were offered AM; all others were recommended for surgical excision. Oncologic outcomes were compared for AM and surgery.

      Results

      111 were included, 21 (19%) meeting LOW. AM occurred in 18 (86%) while 3 elected for excision (with 0% upgrade). Of the 18 LOW in AM, 2 required additional CNB (none at ADH site): 0% were diagnosed with cancer over median 23 month follow-up.

      Conclusions

      There were no missed cancers at ADH site during AM for LOW, confirming the oncologic safety of AM in this select group.
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