Outcomes Study of Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ Treated with Excision
Junqi Qian, Aylin Rizki, Julio Chong, Justin Richey, Jedd Ticar, Liang Shan, Michael Idowu. Virginia Commonwealth University, Richmond, VA
Background: The natural history of low grade ductal carcinoma in situ (DCIS) suggests that the majority of the patients do not progress to invasive carcinoma. While there may be some practice variation, many treat DCIS with excision and radiation. Atypical ductal hyperplasia (ADH) on the other hand is treated with excision without radiation. We evaluated 1) the time to recurrence, 2) the recurrence diagnoses and we compared the frequency of recurrence of ADH and DCIS.
Design: Women with ADH and DCIS treated with excisional biopsy from 1988 to 2006 at the VCUHS Breast Disease Cohort were identified through pathology review. All specimens had negative surgical margins. Only cases with at least 5 year follow-up information are included. Cases with total mastectomy and positive margins are excluded. Subsequent recurrences and/or subsequent development of infiltrating carcinoma on the same side were identified. We determined the prognostic significance of several histopathological characteristics of ADH and DCIS on initial diagnosis including size, and DCIS grade.
Results: There were 220 patients with a mean age of 55 years and a mean follow-up of 81 months (maximum follow-up, 266 months). 112 (51%) were ADH, of which 18/112 (16%) recurred (7ADH, 3 DCIS, 6 infiltrating ductal and 2 infiltrating lobular) with a mean time to recurrence of 45 months. 108 (49%) were DCIS (all grades) of which 23 (22%) recurred (7 ADH, 9 DCIS, 3 IDC, 3 ILC) with a mean time to recurrence of 57 months. The mean initial size of ADH was smaller than DCIS (1.56 vs. 2.17 cm2, P=0.01), but there was no significant difference in age at diagnosis (54 vs. 56 months), recurrent rate (16% vs. 22%), time to recurrence (45 vs. 57 months), and recurrent diagnosis (for each pair, p>0.05). Among DCIS, 62% were high-grade and 38% were low-grade. There was no significant in recurrence rates between low grade and high-grade DCIS (16% vs. 24%), P>0.05). Surprisingly, ADH and low-grade DCIS had an identical (16%) recurrence rate and the size was similar (1.56 vs. 1.71).
Conclusions: In this study, we found that the initial size for DCIS was large than ADH, and low-grade DCIS and ADH had an identical prediction value for the recurrence of atypia and malignancy in the breast. These findings suggest that the management options for ADH and low-grade DCIS should be evaluated carefully.
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 10, Tuesday Afternoon