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Background: The incidence of atypical ductal hyperplasia (ADH) is increasing due to mass screening. Because of the underestimation risk of malignancy, the management remains controversial. Our goal was to analyze clinicopathologic features of patients with ADH diagnosed on directional vacuum-assisted biopsy (DVAB). The objectives of this continuous retrospective study were to evaluate the underestimation rate of malignancy and to identify predictors of upgrade to carcinoma. Methods: Between 2003 and 2010, 3159 patients underwent stereotactic DVAB in our institute. We retrospectively evaluate clinical, mammographic and pathological features of 298 cases of ADH who underwent surgical excision in our center (93.1%). Patients with concurrent history of breast cancer, intraductal carcinoma (DCIS) associated, or with no follow-up or surgical excision on place were excluded. Histological scar of macrobiopsy was systematically searched in surgical specimens. A pathologic upgrade was defined by presence of invasive cancer or DCIS on surgical specimen. Statistical tests used were the chi-square or Fisher's exact test. Results: Among the 298 studied DVAB, 224 ADH were isolated (75.2%), 46 associated to flat epithelial atypia (15.4%) and 28 to lobular neoplasia (9.4%). 98.4% patients presented microcalcifications at diagnosis. In 52 cases, lesions were upgraded to DCIS (n = 38) or invasive cancer (n = 14). The underestimated rate was 17.5%. In 67.3% cases, upgrade lesions were low or intermediate grade DCIS. Only the history of contralateral breast cancer was significantly correlated with the underestimated rate (p = 0.04). There was no statistical difference between these 52 cases and the 246 others for: family history, size of calcification, sampling number, histological lesion, and quality of calcifications removal. Conclusions: In this study, DVAB may not be considered a therapeutic procedure in case of ADH, even in the case of complete removal of microcalcifications. It is still challenging to identify a subgroup of ADH cases with a low upgrade rate. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-14-10.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 40 - N° 4 - p. 297-304

Resume Objectif. – Ce travail a pour but l'analyse des correlations cyto-histologiques pour les frottis cervico-uterins ayant detecte un cancer ou une lesion malpighienne intra-epitheliale de haut grade (HSIL) du col. Patientes et methode. – Il s'agit d'une etude retrospective portant sur 311 femmes. L'âge moyen est egal a 36,4 ans. Le groupe 1 (confirmation histologique de lesion de haut grade ou invasive) comporte 244 femmes (77,5 %). Le groupe 2 (diagnostic histologique autre que lesion de haut grade ou invasive) comporte 37 femmes (11,9 %) avec un diagnostic presume de HSIL. Le groupe 3 (absence de suivi histologique) comporte 30 femmes (9,6 %) avec un diagnostic presume de HSIL. Resultats. – Dans le groupe 1, le diagnostic cytologique presume est HSIL dans 231 cas, carcinome malpighien dans 11 cas et adenocarcinome dans deux cas. Le delai moyen entre le frottis et la premiere histologie est egal a deux mois. Il est superieur a six mois dans sept cas. Le diagnostic de lesion de haut grade ou invasive est confirme histologiquement sur une premiere biopsie de col dans 196 cas, une deuxieme ou une troisieme biopsie dans dix cas, un curetage endocervical dans six cas et une piece d'exerese chirurgicale dans 32 cas. Dans le groupe 2, le diagnostic histologique est normal–benin dans 14 cas (faux-positifs cytologiques presumes) et condylome–CIN1 dans 23 cas (surevaluations presumees). Discussion et conclusion. – Les resultats soulignent l'interet d'echanges interactifs entre cliniciens et pathologistes, et la necessite d'une relecture des cas discordants par plusieurs pathologistes en temps utile avec mention ecrite et codage des conclusions de la relecture. La prise en charge histologique est parfois tardive ou non realisee.