Abstract P6-10-08: Atypical ductal hyperplasia and rate of upgrade to carcinoma on excision at a safety net hospital
Authors: Vo E , Arita NA , Ortiz-Perez T , Awad SS , Hsu C , Silberfein EJ 
Published: February 2018

Abstract
Purpose: Atypical ductal hyperplasia (ADH) is a high-risk lesion associated with an increased risk of developing breast cancer. Surgical excision following diagnosis of ADH on core needle biopsy is generally recommended due to high rate (10-30%) of upgrade to malignancy. Studies have been done to identify factors which may allow for observation rather than excision for management of ADH, however these have not been done in patients who obtain care from safety net health systems. The objective of our study was to examine the rate of upgrade to malignancy in a safety net hospital and to describe factors that may be associated with upstage.
Methods: A retrospective review identified women diagnosed with ADH on core needle biopsy from 2002-2015. Women with a concurrent diagnosis of ductal carcinoma in situ (DCIS) or invasive cancer were excluded. Only women who underwent excision were included in the comparative analysis. Upgrade (UG) was defined as histopathologic diagnosis of DCIS or invasive carcinoma on the excised specimen. Univariate analysis was used to compare baseline and clinical characteristics of the UG vs. non-upgraded (Non-UG) group. Logistic regression was performed to identify factors independently associated with increased odds of upgrade.
Results: ADH was diagnosed in 157 women and 122 (78%) underwent excision. The mean age was 53.3 ± 9.3 years, 48% were Hispanic, and the most common BIRADS score was 4A (58%). On diagnostic imaging, 78% had calcifications, 30% had a mass, and 6% architectural distortion. Time to excision from biopsy varied (median 2.3 months), however most women (81%) underwent excision within 6 months. 35 (29%) patients were upstaged to cancer (22 DCIS, 13 invasive cancer). UG was associated with African-American race (54% vs. non-UG 23%, p&lt;0.01), history of non-breast cancer (11% vs. non-UG 0, p=0.01), BIRADS 5 (9% vs. non-UG 0, p=0.02) and mass on physical exam (36% vs. non-UG 15%, p=0.03) or diagnostic imaging (45% vs. non-UG 25%, p=0.03). Median follow up for the entire cohort was 813 days (IQR 327-1492). In Non-UG, 2 women subsequently developed cancer in a different area from the ADH. On logistic regression, African-American women (compared to Hispanic women, odds ratio [OR] 5.5, 95% confidence interval [CI]: 1.5-20.0, p=0.01) and those with a higher BI-RADS score of 4C and 5 (OR 13.2, 95% CI: 1.6-110.6, p=0.02) had increased odds of upstaging to malignancy.
Conclusion: The rate of upgrade from ADH to cancer was 29% in our cohort. Women diagnosed with ADH in safety net hospitals, particularly African-American women and those with high BIRADS score (4C and 5), should be strongly advised to undergo excision. Further study on the impact of race on the rate of ADH lesions upgrading to malignancy on surgical excision is warranted.
Citation Format: Vo E, Arita NA, Ortiz-Perez T, Awad SS, Hsu C, Silberfein EJ. Atypical ductal hyperplasia and rate of upgrade to carcinoma on excision at a safety net hospital [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-10-08.