Juan Hidalgo MD, Presenter: Nothing to Disclose

Emmanuelle Lemercier MD, Abstract Co-Author: Nothing to Disclose

Shawn Xie PhD, Abstract Co-Author: Nothing to Disclose

Sun Xia, Abstract Co-Author: Nothing to Disclose

Sarkis Meterissian, Abstract Co-Author: Nothing to Disclose

Benoit Delphin Mesurolle MD, Abstract Co-Author: Nothing to Disclose

The purpose of this study is (1) to review the mammographic and sonographic features of breast masses yielding atypical ductal hyperplasia (ADH) at US-guided biopsy, (2) to evaluate the surgical pathology outcome of these lesions, (3) and determine whether clinical or imaging features can be used to predict upgrade to malignancy.

Among 6,327 US-guided biopsies (14-gauge cores) performed at our institution between January 2003 and December 2010, histological analysis yielded 2,070 malignant lesions (32.7%) and 4,255 benign lesions (67.2%) including 56 lesions (0.9%) which showed ADH in 51 patients. Among the 56 lesions containing ADH, 6 patients (6 lesions) were lost to follow-up and therefore not included in this study. The remaining 50 ADH lesions were surgically excised (45 patients). For each lesion, medical records and images were reviewed. Their mammographic and sonographic features were analysed in consensus by 2 radiologists using the BI-RADS Lexicon.

Forty-five patients (mean age, 56 years; 12 < 50 years, 33 >= 50 years) had 50 lesions, (mean lesion size=0.76 cm). Six patients had a synchronous breast carcinoma. Surgical excision showed evidence of malignancy in 28 cases (56% underestimation rate). Mammographically, lesions were not visible (24%, 12/50) or appeared as a mass (24%, 12/50), microcalcifications (14%, 7/50), asymmetric density (20%, 10/50) or distortions (18%, 9/50). Sonographically, they appeared as a mass (94%, 47/50) or a distortion (6%, 3/50). The masses were hypoechoic (65%, 31/47), with irregular shape (51%, 24/47), microlobulated margins (49%, 23/47), no posterior acoustic feature (25/47, 53%), abrupt interface (70%, 33/47) and non-parallel orientation (57%, 27/47). No mammographic and sonographic features were associated with malignant outcome, whereas age < 50 years (P: 0.04), and synchronous malignancy (P: 0.03) were associated with malignant outcome.

ADH diagnosed at sonographically guided 14-gauge core needle biopsy has a high underestimation rate. Presence of a synchronous carcinoma, or age < 50 years are associated with malignant outcome.

Surgical excision should be recommended when ADH is diagnosed at sonographically guided 14-gauge core needle biopsy.

Hidalgo, J, Lemercier, E, Xie, S, Xia, S, Meterissian, S, Mesurolle, B, Atypical Ductal Hyperplasia Diagnosed at US-guided Core Needle Biopsy: Final Surgical Outcome and Factors Associated with Underestimation.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12035251.html