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Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy

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Abstract

Background The aim of this study was to determine factors that predict under-evaluation of malignancy in patients diagnosed with atypical ductal hyperplasia (ADH) at ultrasound-guided core needle biopsy (CNB), and to develop a prediction algorithm for scoring the possibility of a diagnosis upgrade to malignancy based on clinical, radiological and pathological factors. Methods The study enrolled patients diagnosed with ADH at ultrasound-guided CNB who subsequently underwent surgical excision of the lesion. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy. Results A total of 102 patients with ADH at CNB were identified. Of the 74 patients who underwent subsequent surgical excision, 34 (45.8%) were diagnosed with invasive or in situ malignant foci. Multivariate analysis revealed that age >50 years, microcalcification on mammography, size on imaging >15 mm and a palpable lesion were independent predictors of malignancy. Focal ADH was a negative predictor. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.903 (95% CI: 0.82–0.94), and the negative predictive value was 100% for a score ≤3.5. Similar findings were observed for a validation dataset of 54 patients at other institutions. Conclusions A scoring system to predict malignancy in patients diagnosed with ADH at CNB was developed based on five factors: age, palpable lesion, microcalcification on mammography, size on imaging and focal ADH. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate.

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Acknowledgements

This work supported by a grant from the Seoul National university Hospital Research Fund (03-2004-014-0), and a grant from the Stem Cell Research Center, 21st Century Frontier R&D Program funded by the Ministry of Science & Technology of Korea (SC-3180).

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Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    Eunyoung Ko, Jong Won Lee, Jihyoung Cho, Eun-Kyu Kim, So-Youn Jung & Mee Joo Kang

  2. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110–744, Korea

    Wonshik Han & Dong-Young Noh

  3. Department of Radiology, Seoul National University College of Medicine, Seoul, Korea

    Woo Kyung Moon

  4. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

    In Ae Park

  5. Department of Surgery, Seoul National University Bundang Hospital, Sungnam-si, Korea

    Sung-Won Kim & Ku Sang Kim

  6. Center for Breast Cancer, National Cancer Center, Goyang-si, Korea

    Eun Sook Lee, Kyu Hong Min & Seok Won Kim

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  1. Eunyoung Ko
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  2. Wonshik Han
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  8. Woo Kyung Moon
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  10. Sung-Won Kim
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  13. Kyu Hong Min
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  15. Dong-Young Noh
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Correspondence to Dong-Young Noh.

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Ko, E., Han, W., Lee, J.W. et al. Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy. Breast Cancer Res Treat 112, 189–195 (2008). https://doi.org/10.1007/s10549-007-9824-0

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  • DOI: https://doi.org/10.1007/s10549-007-9824-0

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