Breast MRI assists in decision-making for surgical excision of atypical ductal hyperplasia

Trends in Atypical Ductal Hyperplasia Diagnosis and Upgrade: A 20-Year Experience and Impact of MRI Use on Upgrade Rates

BACKGROUND

Atypical ductal hyperplasia (ADH) is a benign proliferative breast lesion. Surgical excision of ADH is often recommended to rule out underlying malignant disease.

OBJECTIVE

The aim of this study was to evaluate the trends in ADH upgrade rates over time and identify the impact of magnetic resonance imaging (MRI) use on upgrade rates.

METHODS

Retrospective review of a prospectively maintained institutional database was used to identify women diagnosed with ADH by core needle biopsy between 2004 and 2022. Trends in ADH upgrade to in situ and invasive disease as well as clinicopathologic factors associated with upgrade were analyzed.

RESULTS

A total of 975 ADH cases were identified between 2004 and 2022. Of these, 361 (37.0%) met our multidisciplinary criteria for excision and thus met the inclusion criteria for this study. A total of 93 (25.8%) patients were found to have upgrade on final surgical pathology. When compared across quartiles of time, there were no significant changes in overall rates of upgrade over the study time period despite changes in diagnostic modalities. In women selectively referred for excision based on standardized imaging and pathology criteria, enhancement on preoperative MRI was not found to be significantly associated with increased rates of ADH upgrade.

CONCLUSION

While trends in diagnostic modality of ADH have changed over time, we found that rates of ADH upgrade have remained stable over time and are not associated with imaging modality, suggesting that enhancements in imaging technology have not improved our ability to preoperatively identify patients with a concurrent malignancy.