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Atypical Ductal Hyperplasia: Can Some Lesions Be Defined as Probably Benign after Stereotactic 11-gauge Vacuum-assisted Biopsy, Eliminating the Recommendation for Surgical Excision?¹

¹ From the Department of Radiology, Palo Alto Medical Clinic, 795 El Camino Real, Palo Alto, CA 94301 (R.J.J.); and the Department of Radiology, Stanford University Medical Center, Stanford, Calif (R.L.B., D.M.I.). From the 2001 RSNA scientific assembly. Received September 14, 2001; revision requested November 15; revision received January 9, 2002; accepted March 12. Supported in part by an educational grant from Biopsys Medical to the Palo Alto Medical Foundation. Address correspondence to R.J.J. (e-mail: jackmanr@pamf.org).

PURPOSE: To determine if a subset of atypical ductal hyperplasia (ADH) lesions diagnosed at 11-gauge, directional, vacuum-assisted, prone, stereotactic biopsy fit the "probably benign" definition of a less than 2% chance of being carcinoma at subsequent surgical excision.

MATERIALS AND METHODS: Clinical, mammographic, and stereotactic biopsy features in 104 consecutive nonpalpable ADH lesions were correlated with the presence of carcinoma at lumpectomy. The results were analyzed with ² statistic, with P < .05 indicative of significant difference.

RESULTS: Surgical excision revealed carcinoma in 22 (21%) of 104 ADH lesions. The lowest incidences of carcinoma (each P < .02) were 16% (15 of 92) in patients with no personal history of breast carcinoma, 13% (nine of 67) when maximum lesion diameter was less than 10 mm, and 8% (three of 36) when 100% of the mammographic lesion was removed at stereotactic biopsy.

CONCLUSION: No clinical, mammographic, or biopsy features alone or in combination could be used to define a substantial subset of probably benign lesions with a less than 2% chance of carcinoma at lumpectomy.

© RSNA, 2002

Index terms: Biopsies, technology • Breast, biopsy, 00.1261, 00.1267 • Breast, ducts, 00.711 • Breast neoplasms, diagnosis, 00.32, 00.81

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