Atypical ductal hyperplasia

ADH, generally, is asymptomatic. It usually comes to medical attention on a screening mammogram, as a non-specific suspicious abnormality that requires a biopsy.

ADH, cytologically, architecturally and on a molecular basis, is identical to a low-grade ductal carcinoma in situ (DCIS);{{Cite journal | last1 = Ghofrani | first1 = M. | last2 = Tapia | first2 = B. | last3 = Tavassoli | first3 = FA. | title = Discrepancies in the diagnosis of intraductal proliferative lesions of the breast and its management implications: results of a multinational survey | journal = Virchows Arch | volume = 449 | issue = 6 | pages = 609–16 |date=Dec 2006 | doi = 10.1007/s00428-006-0245-y | pmid = 17058097 | pmc=1888715}} however, it has a limited extent, i.e. is present in a very small amount (< 2 mm).

Image:Atypical ductal hyperplasia - low mag.jpg | Low mag.

Image:Atypical ductal hyperplasia - high mag.jpg | High mag.

While the histopathologic features and molecular features of ADH are that of (low-grade) DCIS, its clinical behaviour, unlike low-grade DCIS, is substantially better; thus, the more aggressive treatment for DCIS is not justified.

File:Atypical ductal hyperplasia with immunotyping.jpg

It is diagnosed based on tissue, e.g. a biopsy,{{cite journal |vauthors=Eby PR, Ochsner JE, DeMartini WB, Allison KH, Peacock S, Lehman CD |title=Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum-assisted breast biopsy: 9-versus 11-gauge |journal=AJR Am J Roentgenol |volume=192 |issue=1 |pages=229–34 |date=January 2009 |pmid=19098204 |doi=10.2214/AJR.08.1342 |url=http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=19098204}} showing ductal hyperplasia.

There is no single definite cutoff that separates atypical ductal hyperplasia from ductal carcinoma in situ, but the following are important distinctive features of atypical ductal hyperplasia, with suggested cutoffs:{{cite journal|last1=Tozbikian|first1=Gary|last2=Brogi|first2=Edi|last3=Vallejo|first3=Christina E.|last4=Giri|first4=Dilip|last5=Murray|first5=Melissa|last6=Catalano|first6=Jeffrey|last7=Olcese|first7=Cristina|last8=Van Zee|first8=Kimberly J.|last9=Wen|first9=Hannah Yong|title=Atypical Ductal Hyperplasia Bordering on Ductal Carcinoma In Situ|journal=International Journal of Surgical Pathology|volume=25|issue=2|year=2016|pages=100–107|issn=1066-8969|doi=10.1177/1066896916662154|pmid=27481892 |pmc=5285492}}

• Size less than 2 mm.
• Not involving more than one duct.
• The atypical epithelial proliferation is admixed with a second population of proliferative cells without atypia.
• The proliferation completely involves the terminal ductal lobular unit(s), to a limited extent.

ADH, if found on a surgical (excisional) biopsy of a mammographic abnormality, does not require any further treatment, only mammographic follow-up.

If ADH is found on a core (needle) biopsy (a procedure which generally does not excise a suspicious mammographic abnormality), a surgical biopsy, i.e. a breast lumpectomy, to completely excise the abnormality and exclude breast cancer is the typical recommendation.

The rate at which breast cancer (ductal carcinoma in situ or invasive mammary carcinoma (all breast cancer except DCIS and LCIS)) is found at the time of a surgical (excisional) biopsy, following the diagnosis of ADH on a core (needle) biopsy varies considerably from hospital-to-hospital (range 4-54%).{{Cite journal | last1 = Deshaies | first1 = I. | last2 = Provencher | first2 = L. | last3 = Jacob | first3 = S. | last4 = Côté | first4 = G. | last5 = Robert | first5 = J. | last6 = Desbiens | first6 = C. | last7 = Poirier | first7 = B. | last8 = Hogue | first8 = JC. | last9 = Vachon | first9 = E. | title = Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy | journal = Breast | volume = 20 | issue = 1 | pages = 50–5 |date=Feb 2011 | doi = 10.1016/j.breast.2010.06.004 | pmid = 20619647 | doi-access = free }} In two large studies, the conversion of an ADH on core biopsy to breast cancer on surgical excision, known as "up-grading", is approximately 30%.{{Cite journal | last1 = Margenthaler | first1 = JA. | last2 = Duke | first2 = D. | last3 = Monsees | first3 = BS. | last4 = Barton | first4 = PT. | last5 = Clark | first5 = C. | last6 = Dietz | first6 = JR. | title = Correlation between core biopsy and excisional biopsy in breast high-risk lesions | journal = Am J Surg | volume = 192 | issue = 4 | pages = 534–7 |date=Oct 2006 | doi = 10.1016/j.amjsurg.2006.06.003 | pmid = 16978969 }}

The relative risk of breast cancer based on a median follow-up of 8 years, in a case control study of US registered nurses, is 3.7.{{Cite journal | last1 = London | first1 = SJ. | last2 = Connolly | first2 = JL. | last3 = Schnitt | first3 = SJ. | last4 = Colditz | first4 = GA. | title = A prospective study of benign breast disease and the risk of breast cancer | journal = JAMA | volume = 267 | issue = 7 | pages = 941–4 |date=Feb 1992 | doi = 10.1001/jama.1992.03480070057030| pmid = 1734106 }}

• Ductal carcinoma in situ
• Breast cancer
• Collagenous spherulosis

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• [http://www.hopkinsmedicine.org/avon_foundation_breast_center/breast_cancers_other_conditions/atypical_ductal_hyperplasia.html What is atypical ductal hyperplasia? (hopkinsmedicine.org)]

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Category:Benign neoplasms

Category:Breast neoplasia