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ADH: To excise or not to excise, that is the question

Published:November 11, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.055
      In this issue of AJS, Estrada et al. reported oncologic safety of active monitoring (AM) of atypical ductal hyperplasia (ADH) in retrospective study including 111 patients from 10/2015 to 03/2020.

      Estrada J, Larson KE, Kilgore LJ, et al. Safety of de-escalation of surgical intervention for atypical ductal hyperplasia on percutaneous biopsy: one size does not fit all. Am J Surg. 2022 Sep 24:S0002-9610(22)00593-1.

      This study is an important contribution to our understanding of AM for ADH, complementing the works from two other institutions, The University of Texas MD Anderson Cancer Center (MDACC) and the Mayo Clinic, which have reported on the safety of this approach.
      • Nguyen C.V.
      • Albarracin C.T.
      • Whitman G.J.
      • Lopez A.
      • Sneige N.
      Atypical ductal hyperplasia in directional vacuum-assisted biopsy of breast microcalcifications: considerations for surgical excision.
      • Menen R.S.
      • Ganesan N.
      • Bevers T.
      • et al.
      Long-term safety of observation in selected women following core biopsy diagnosis of atypical ductal hyperplasia.
      • Peña A.
      • Shah S.S.
      • Fazzio R.T.
      • et al.
      Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia.
      The current guidelines including National Comprehensive Cancer Network (NCCN) and the American Society of Breast Surgeons (ASBrS) recommends surgical excision for most cases of ADH.
      • Bevers T.B.
      • Ward J.H.
      • Arun B.K.
      • et al.
      Breast cancer risk reduction, version 2.2015.
      ,

      Consensus Guideline on Concordance Assessment of Image-Guided Breast Biopsies and Management of Borderline or High-Risk Lesions. :12.

      However, Estrada et al. demonstrated that AM is a safe alternative to surgical excision for a select subgroup of patients with ADH by showing that there were no missed malignancies at the site of ADH in patients who met low-risk criteria. The study from MDACC, showed upgrade to malignancy ranged from 0%, in a 2011 study that included 19 patients, to 5.6%, in a 2017 study that included 50 patients.
      • Nguyen C.V.
      • Albarracin C.T.
      • Whitman G.J.
      • Lopez A.
      • Sneige N.
      Atypical ductal hyperplasia in directional vacuum-assisted biopsy of breast microcalcifications: considerations for surgical excision.
      ,
      • Menen R.S.
      • Ganesan N.
      • Bevers T.
      • et al.
      Long-term safety of observation in selected women following core biopsy diagnosis of atypical ductal hyperplasia.
      Similarly, Pena et al. found an upgrade rate of 4.9% for their patients who met low-risk criteria.
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      References

      1. Estrada J, Larson KE, Kilgore LJ, et al. Safety of de-escalation of surgical intervention for atypical ductal hyperplasia on percutaneous biopsy: one size does not fit all. Am J Surg. 2022 Sep 24:S0002-9610(22)00593-1.

        • Nguyen C.V.
        • Albarracin C.T.
        • Whitman G.J.
        • Lopez A.
        • Sneige N.
        Atypical ductal hyperplasia in directional vacuum-assisted biopsy of breast microcalcifications: considerations for surgical excision.
        Ann Surg Oncol. 2011; 18: 752-761https://doi.org/10.1245/s10434-010-1127-8
        • Menen R.S.
        • Ganesan N.
        • Bevers T.
        • et al.
        Long-term safety of observation in selected women following core biopsy diagnosis of atypical ductal hyperplasia.
        Ann Surg Oncol. 2017; 24: 70-76https://doi.org/10.1245/s10434-016-5512-9
        • Peña A.
        • Shah S.S.
        • Fazzio R.T.
        • et al.
        Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia.
        Breast Cancer Res Treat. 2017; 164: 295-304https://doi.org/10.1007/s10549-017-4253-1
        • Bevers T.B.
        • Ward J.H.
        • Arun B.K.
        • et al.
        Breast cancer risk reduction, version 2.2015.
        J Natl Compr Cancer Netw. 2015; 13: 880-915https://doi.org/10.6004/jnccn.2015.0105
      2. Consensus Guideline on Concordance Assessment of Image-Guided Breast Biopsies and Management of Borderline or High-Risk Lesions. :12.

        • Grimm L.J.
        • Shelley Hwang E.
        Active surveillance for DCIS: the importance of selection criteria and monitoring.
        Ann Surg Oncol. 2016; 23: 4134-4136https://doi.org/10.1245/s10434-016-5596-2
        • Sergesketter A.R.
        • Thomas S.M.
        • Fayanju O.M.
        • et al.
        The influence of age on the histopathology and prognosis of atypical breast lesions.
        J Surg Res. 2019; 241: 188-198https://doi.org/10.1016/j.jss.2019.03.047
        • Johnson M.
        • Stanczak B.
        • Winblad O.D.
        • Amin A.L.
        Breast MRI assists in decision-making for surgical excision of atypical ductal hyperplasia.
        Surgery. 2022; https://doi.org/10.1016/j.surg.2022.07.036