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.
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.
2
,
3
,
4
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.
5
,6
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.
2
,3
Similarly, Pena et al. found an upgrade rate of 4.9% for their patients who met low-risk
criteria.To read this article in full you will need to make a payment
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References
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.
- 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
- 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
- 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
- Breast cancer risk reduction, version 2.2015.J Natl Compr Cancer Netw. 2015; 13: 880-915https://doi.org/10.6004/jnccn.2015.0105
Consensus Guideline on Concordance Assessment of Image-Guided Breast Biopsies and Management of Borderline or High-Risk Lesions. :12.
- 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
- 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
- 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
Article Info
Publication History
Published online: November 11, 2022
Accepted:
October 25,
2022
Received:
October 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
