Predicting cancer on excision of atypical ductal hyperplasia

Background There are no specific histopathologic factors that allow identification of patients with atypical ductal hyperplasia (ADH) who will have cancer on final excision. Methods This was a retrospective study of all patients who had ADH on biopsy followed by excision from 1999 to 2006. Results Fifty-one patients were found to have ADH on core biopsy. Eight (15.7%) patients had invasive carcinoma on surgical excision, 9 (17.5%) had ductal carcinoma-in-situ (DCIS), 21 (41.5%) had ADH, 4 (8%) patients had atypical lobular hyperplasia, and 9 (17.5%) had benign tumors. The grade of atypia on the core biopsy was mild in 13 (25%) patients, moderate in 22 (43%), and marked in 16 (32%). On multivariate analysis of histopathologic factors, the grade of atypia was the only significant variable that predicted a diagnosis of cancer on final surgical excision (P = .001). Conclusions The grade of atypia correlated with the presence of cancer on surgical excision.