Atypical Ductal Hyperplasia of the Breast Diagnosed by Ultrasonographically Guided Core Needle Biopsy

Zusammenfassung

Ziel: Wir analysierten die sonografischen (US) Charakteristika der mittels ultraschallgestützten Stanzbiopsie (CNB) diagnostizierten atypischen duktalen Hyperplasie (ADH) der Mamma mit dem Ziel, Faktoren zu identifizieren, die zur Unterschätzung der Diagnose ADH führen. Material und Methoden: Insgesamt wurden 134 ADH-Läsionen, die mittels CNB untersucht wurden, retrospektiv analysiert. Alle Läsionen wurden nach Muster, Größe, Läsionscharakteristika und Grenzen beurteilt und das zugehörige chirurgische (histopathologische) Outcome und die Ergebnisse der Follow-up-Bildgebung wurden ermittelt. Die klinischen und radiologischen Befunde aller Patienten wurden im Hinblick auf Unterschätzung der Diagnose ADH analysiert. Ergebnisse: Die Malignitätsrate in den verschiedenen Läsionsmustern nach chirurgischer Exzision betrug 32 / 81 (40 %) für solide Raumforderungen, 14 / 31 (45 %) für duktale Strukturen, 5 / 17 (29 %) für komplex zystische Läsionen und 2 / 5 (40 %) für Läsionen mit architektonischer Unruhe. Entsprechend der chirurgischen bzw. US-Follow-up-Untersuchungen war keine der Kategorie-3-Läsionen maligne. Malignitätskriterien wurden bei 17 / 80 (21 %) der BI-RADS(Breast Imaging Reporting and Data System)-Kategorie-4a-Läsionen, bei 20 / 27 (74 %) der Kategorie-4b-Läsionen, bei 12 / 13 (92 %) der Kategorie-4c-Läsionen und bei 4 / 4 (100 %) der Kategorie-5-Läsionen gefunden. Läsionen mit höherer US-Bewertungskategorie, solche ohne scharfen Rand oder solche mit mammografischem Malignitätsverdacht waren alle signifikant mit dem Risiko der Diagnose-Unterschätzung assoziiert (p < 0,05 für jedes Kriterium). Schlussfolgerung: US ist wertvoll zur Beurteilung von ADH-Läsionen und hilft bei der Indikationsstellung zur Biopsie. Die diagnostischen Abklärung dieser Läsionen kann durch Kenntnis der Malignitätsrate verschiedener US-Befunde zusätzlich verbessert werden.

Abstract

Purpose: We analysed the ultrasonographic (US) features of atypical ductal hyperplasia (ADH) of the breast diagnosed by US-guided core needle biopsy (CNB) with the aim of identifying factors that affect the underestimation of ADH. Materials and Methods: A total of 134 ADH lesions sampled by US-guided CNB were reviewed retrospectively. All lesions were evaluated for pattern, size, lesion characteristics and margins, and the corresponding surgical outcome or imaging follow-up was obtained. Each patient’s clinical and radiological features were analysed to identify factors involved in ADH underestimation. Results: The prevalence of malignancy in each pattern of lesions following surgical excision was 32 / 81 (40 %) for solid masses, 14 / 31 (45 %) for ductal patterns, 5 / 17 (29 %) for complex cystic lesions and 2 / 5 (40 %) for architectural distortions. Based on the results of surgical and US follow-up, none of the category 3 lesions was proven to be a malignancy. Malignancy was found in 17 (21 %) of the 80 BI-RADS (Breast Imaging Reporting and Data System) category 4a lesions, 20 (74 %) of the 27 category 4b lesions, 12 (92 %) of the 13 category 4c lesions, and four (100 %) of the four category 5 lesions. Lesions with a higher US assessment category, lacking circumscribed margins, or a mammographic finding of suspected malignancy were all significantly associated with underestimation (p < 0.05 for each). Conclusion: US is useful in evaluating ADH lesions and in clarifying the indication for biopsy of these lesions. Familiarity with the frequency associated with malignancy for each feature will improve the utility of US in the work-up of these breast abnormalities.

Key words

breast - ultrasound - mammography

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