Annals of Surgical Oncology Cite Track
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10.1245/s10434-007-9681-4
Annals of Surgical Oncology 15:843-847 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Atypical Ductal Hyperplasia at Margin of Breast Biopsy—Is Re-Excision Indicated?

Shalini Arora, MD1, Tehillah S. Menes, MD1,2, Christine Moung, MD3, Chandandeep Nagi, MD3, Ira Bleiweiss, MD3 and Shabnam Jaffer, MD3

1 Department of Surgery, Mount Sinai Medical Center, New York, NY, USA
2 Department of Surgery, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, USA
3 Department of Pathology, Mount Sinai Medical Center, New York, NY, USA

Correspondence: Address correspondence and reprint requests to: Tehillah S. Menes, MD; E-mail: menest{at}nychhc.org

Background: Atypical duct hyperplasia (ADH) observed during core needle biopsy is associated with a high rate of cancer upon excision. Controversy exists regarding the need to re-excise ADH involving a margin. The purpose of this study was to determine the rate of residual pathology in patients that underwent re-excision for ADH involving the margin.

Methods: In a retrospective review of the pathology database from 1 January 2000 to 1 June 2006, we identified 44 lumpectomy specimens with ADH involving the margin; 24 patients (55%) had a re-excision. Slides were reviewed to verify the diagnosis of ADH near the margin and the presence of residual disease on re-excision associated with the biopsy cavity.

Results: Patients had pure ADH (15, 63%), ADH and ductal carcinoma in situ (DCIS) (7, 29%) or ADH with invasive carcinoma (2, 8%). Residual ADH or cancer was found in 14 of 24 patients (58%). Of 15 patients with pure ADH, 6 (40%) had residual pathology: ADH (2), DCIS (2) and invasive carcinoma (2). In this group, 27% of patients were reassessed as having DCIS or invasive carcinoma. Of the 9 patients with cancer, 8 (89%) had residual disease in the form of ADH (4) or DCIS (4).

Conclusions: ADH found at the margin of a lumpectomy specimen is associated with a high rate of residual ADH and cancer. Over one quarter of the patients with an initial diagnosis of ADH were reassessed as having DCIS or invasive carcinoma. Re-excision in all patients with ADH involving the margin is recommended.

Key Words: Atypical duct hyperplasia • Breast • Lumpectomy • Margins • Re-excision






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