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Ann Surg Oncol (2017) 24:7076 DOI 10.1245/s10434-016-5512-9
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Web End = ORIGINAL ARTICLE BREAST ONCOLOGY
Long-Term Safety of Observation in Selected Women Following Core Biopsy Diagnosis of Atypical Ductal Hyperplasia
Rhiana S. Menen, MD1, Nivetha Ganesan, BS1, Therese Bevers, MD2, Jun Ying, MS3, Robin Coyne, RN, MSN2, Deanna Lane, MD4, Constance Albarracin, MD5, and Isabelle Bedrosian, MD1
1Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX;
2Department of Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX; 3Department of Biostatics, The University of Texas MD Anderson Cancer Center, Houston, TX; 4Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX; 5Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
ABSTRACTPurpose. Atypical ductal hyperplasia (ADH) found on core biopsy is associated with an upgrade to carcinoma in 1030 % of women, thus surgical excision remains the standard of care. This study compares the incidence of breast cancer in women with ADH who were observed with those who underwent surgical excision of the ADH site.Methods. Our departmental, prospectively maintained registry was reviewed to identify patients with ADH diagnosed by core biopsy. Surgically treated patients were excluded if upstaged to carcinoma following excision for ADH diagnosis. Breast cancer events were classied as index site (site of ADH biopsy), ipsilateral breast unrelated to index site, or contralateral breast.
Results. Overall, 175 women met the study criteria; 125 were observed and 50 underwent excision. With a median follow-up of 3 years, 14 breast cancer events were noted in 13 patients. In the surgery group, six women developed breast cancer (12 %), including one bilateral, compared with seven cancers (5.6 %) in the observed group (p = 0.14). Index site events and ipsilateral cancers were the same in both groups [2 vs. 0.8 % (p = 0.49) and 4 versus 4.8 % (p = 1.00), respectively]. All contralateral cancers occurred in the surgical group (8 vs. 0 %; p \ 0.01). A prior history of breast cancer was the only variable associated with subsequent breast cancer events (hazard ratio 12.53, 95 % condence interval 3.3047.57).
Conclusion. Observation is appropriate in selected women with ADH on core biopsy. Index site failures are...