Atypical Ductal Hyperplasia of the Breast on Core Needle Biopsy: Risk of Malignant Upgrade On Surgical Excision
Tiffany Sin Hui Bong, Jun Kiat Thaddaeus Tan, Juliana T.S. Ho, Puay Hoon Tan, Wing Sze Lau, Tuan Meng Tan, Jill Su Lin Wong, Veronique Kiak Mien Tan, Benita Kiat Tee Tan, Preetha Madhukumar, Wei Sean Yong, Sue Zann Lim, Chow Yin Wong, Kong Wee Ong, Yirong Sim
Abstract
PURPOSE: This study identified factors predicting malignant upgrade for atypical ductal hyperplasia (ADH) diagnosed on core-needle biopsy (CNB) and developed a nomogram to facilitate evidence-based decision making. METHODS: This retrospective analysis included women diagnosed with ADH at the National Cancer Centre Singapore (NCCS) in 2010-2015. Cox proportional hazards regression was used to identify clinical, radiological, and histological factors associated with malignant upgrade. A nomogram was constructed using variables with the strongest associations in multivariate analysis. Multivariable logistic regression coefficients were used to estimate the predicted probability of upgrade for each factor combination. RESULTS: 0.002) remained significant in multivariate analysis and were included in the nomogram. CONCLUSION: Our model provided good discrimination of breast cancer risk prediction (C-statistic of 0.81; 95% CI, 0.74-0.88) and selected for a subset of women at low risk (2.1%) of malignant upgrade, who may avoid surgical excision following a CNB diagnosis of ADH.