Factors for Breast Cancer in a Patient Diagnosed with Atypical Ductal Hyperplasia at Core Needle Biopsy, a Case Report

Mark Gabriel Galvez. MD, Germaine Gelacio. MD, Jonathan Mendoza. MD

Background: Atypical Ductal Hyperplasia (ADH) is a borderline lesion on histology, and is associated with an increased risk of developing breast cancer and may coexist with DCIS or invasive cancer. Percutaneous core needle biopsy (CNB) is a well-established alternative to surgical biopsy that provides a faster, less invasive, and less expensive method for the histological assessment of breast lesions. But, CNB is less reliable for diagnosing atypical ductal hyperplasia (ADH). The purpose of this paper is to determine the possible factors for breast cancer in patients diagnosed with atypical ductal hyperplasia by core needle biopsy done at St. Luke’s Medical Center Quezon City Breast Center.

Methods: From January 2010 to December 2014, consecutive core needle biopsies were performed on suspicious breast lesions at St. Luke’s Medical Center, Quezon City- Breast Center. A total of 12 biopsies led to a diagnosis of atypical ductal hyperplasia, and 6 patients underwent follow-up surgical excision. Records were reviewed and presented.

Results: Twelve patients were diagnosed with ADH at CNB. Of these patients, 6 underwent surgical excision and 1 (16.67%) was subsequently diagnosed with a malignancy (Ductal Carcinoma-in-situ). Significant factors include mammography that showed microcalcifications in a tight cluster with an associated focal distortion with size of <1cm. A stereotactic core biopsy was used with >5 total number of cores.

Conclusion: A prospective analytical study is recommended to predict independent factors that may lead to breast cancer for patient diagnosed with ADH on core needle biopsy. Surgical excision remained the recommended management for patients with ADH on core needle biopsy.