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A Comprehensive Guide to Core Needle Biopsies of the Breast pp 337–375Cite as

Intraductal Proliferations (DCIS, ADH, and UDH)

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Abstract

The diagnostic evaluation of intraductal proliferations, including ductal carcinoma in situ (DCIS), atypical ductal hyperplasia (ADH), and usual ductal hyperplasia (UDH) is one of the most common diagnostic challenges in breast pathology. While proliferations on the ends of this diagnostic spectrum (high-grade DCIS and classic usual ductal hyperplasia) are usually more straightforward to classify, the distinction between low-grade DCIS and ADH can be particularly problematic. An understanding of the biology of these lesions reveals more about their complexity and which lesions are more closely related to each other. When evaluating intraductal proliferations on core needle biopsy samples, pathologists should understand the critical aspects of establishing these diagnoses as well as their clinical impact. This chapter will review practical approaches to the diagnosis of intraductal proliferative lesions on core biopsy as well as some of their diagnostic challenges and clinical implications.

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References

  1. Elmore JG, Longton GM, Carney PA, et al. Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 2015;313(11):1122–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Allison KH, Reisch LM, Carney PA, et al. Understanding diagnostic variability in breast pathology: lessons learned from an expert consensus review panel. Histopathology. 2014;65(2):240–51.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Tavassoli FA, Norris HJ. A comparison of the results of long-term follow-up for atypical intraductal hyperplasia and intraductal hyperplasia of the breast. Cancer. 1990;65(3):518–29.

    Article  CAS  PubMed  Google Scholar 

  4. Betsill Jr WL, Rosen PP, Lieberman PH, Robbins GF. Intraductal carcinoma. Long-term follow-up after treatment by biopsy alone. JAMA. 1978;239(18):1863–7.

    Article  PubMed  Google Scholar 

  5. Collins LC, Tamimi RM, Baer HJ, Connolly JL, Colditz GA, Schnitt SJ. Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy: results from the Nurses’ Health Study. Cancer. 2005;103(9):1778–84.

    Article  PubMed  Google Scholar 

  6. Page DL, Dupont WD, Rogers LW, Jensen RA, Schuyler PA. Continued local recurrence of carcinoma 15-25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy. Cancer. 1995;76(7):1197–200.

    Article  CAS  PubMed  Google Scholar 

  7. Sanders ME, Schuyler PA, Dupont WD, Page DL. The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer. 2005;103(12):2481–4.

    Article  PubMed  Google Scholar 

  8. Page DL, Dupont WD, Rogers LW, Landenberger M. Intraductal carcinoma of the breast: follow-up after biopsy only. Cancer. 1982;49(4):751–8.

    Article  CAS  PubMed  Google Scholar 

  9. Allison KH, Abraham LA, Weaver DL, et al. Trends in breast biopsy pathology diagnoses among women undergoing mammography in the United States: a report from the Breast Cancer Surveillance Consortium. Cancer. 2015;121(9):1369–78.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kerlikowske K. Epidemiology of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010(41):139–41.

    Article  PubMed  Google Scholar 

  11. Sorum R, Hofvind S, Skaane P, Haldorsen T. Trends in incidence of ductal carcinoma in situ: the effect of a population-based screening programme. Breast. 2010;19(6):499–505.

    Article  PubMed  Google Scholar 

  12. Sacchini V, Fortunato L, Cody Iii HS, Van Zee KJ, Cutuli B, Bonanni B. Breast ductal carcinoma in situ. Int J Surg Oncol. 2012;2012:753267.

    PubMed  PubMed Central  Google Scholar 

  13. Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst. 2010;102(3):170–8.

    Article  PubMed  Google Scholar 

  14. Hofvind S, Sorum R, Thoresen S. Incidence and tumor characteristics of breast cancer diagnosed before and after implementation of a population-based screening-program. Acta Oncol. 2008;47(2):225–31.

    Article  PubMed  Google Scholar 

  15. Ernster VL, Ballard-Barbash R, Barlow WE, et al. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst. 2002;94(20):1546–54.

    Article  PubMed  Google Scholar 

  16. Evans DG, Kesavan N, Lim Y, et al. MRI breast screening in high-risk women: cancer detection and survival analysis. Breast Cancer Res Treat. 2014;145(3):663–72.

    Article  PubMed  Google Scholar 

  17. Lester SC, Bose S, Chen YY, et al. Protocol for the examination of specimens from patients with ductal carcinoma in situ of the breast. Arch Pathol Lab Med. 2009;133(1):15–25.

    PubMed  Google Scholar 

  18. Stomper PC, Margolin FR. Ductal carcinoma in situ: the mammographer’s perspective. AJR Am J Roentgenol. 1994;162(3):585–91.

    Article  CAS  PubMed  Google Scholar 

  19. Lehman CD. Magnetic resonance imaging in the evaluation of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010(41):150–1.

    Article  PubMed  Google Scholar 

  20. Kuhl CK, Schrading S, Bieling HB, et al. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 2007;370(9586):485–92.

    Article  PubMed  Google Scholar 

  21. Riedl CC, Luft N, Bernhart C, et al. Triple-modality screening trial for familial breast cancer underlines the importance of magnetic resonance imaging and questions the role of mammography and ultrasound regardless of patient mutation status, age, and breast density. J Clin Oncol. 2015;33(10):1128–35.

    Article  PubMed  Google Scholar 

  22. Borgquist S, Zhou W, Jirstrom K, et al. The prognostic role of HER2 expression in ductal breast carcinoma in situ (DCIS); a population-based cohort study. BMC Cancer. 2015;15:468.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Gradishar WJ, Anderson BO, Balassanian R, et al. Breast Cancer Version 2.2015. J Natl Compr Canc Netw. 2015;13(4):448–75.

    CAS  PubMed  Google Scholar 

  24. Shin SJ, Rosen PP. Pregnancy-like (pseudolactational) hyperplasia: a primary diagnosis in mammographically detected lesions of the breast and its relationship to cystic hypersecretory hyperplasia. Am J Surg Pathol. 2000;24(12):1670–4.

    Article  CAS  PubMed  Google Scholar 

  25. Bur ME, Zimarowski MJ, Schnitt SJ, Baker S, Lew R. Estrogen receptor immunohistochemistry in carcinoma in situ of the breast. Cancer. 1992;69(5):1174–81.

    Article  CAS  PubMed  Google Scholar 

  26. Allred DC, Anderson SJ, Paik S, et al. Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol. 2012;30(12):1268–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010;28(16):2784–95.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ho GH, Calvano JE, Bisogna M, et al. In microdissected ductal carcinoma in situ, HER-2/neu amplification, but not p53 mutation, is associated with high nuclear grade and comedo histology. Cancer. 2000;89(11):2153–60.

    Article  CAS  PubMed  Google Scholar 

  29. van de Vijver MJ, Peterse JL, Mooi WJ, et al. Neu-protein overexpression in breast cancer. Association with comedo-type ductal carcinoma in situ and limited prognostic value in stage II breast cancer. N Engl J Med. 1988;319(19):1239–45.

    Article  PubMed  Google Scholar 

  30. Collins LC, Schnitt SJ. HER2 protein overexpression in estrogen receptor-positive ductal carcinoma in situ of the breast: frequency and implications for tamoxifen therapy. Mod Pathol. 2005;18(5):615–20.

    Article  CAS  PubMed  Google Scholar 

  31. Sek P, Zawrocki A, Biernat W, Piekarski JH. HER2 molecular subtype is a dominant subtype of mammary Paget’s cells. An immunohistochemical study. Histopathology. 2010;57(4):564–71.

    Article  PubMed  Google Scholar 

  32. Tot T. Early (<10 mm) HER2-positive invasive breast carcinomas are associated with extensive diffuse high-grade DCIS: implications for preoperative mapping, extent of surgical intervention, and disease-free survival. Ann Surg Oncol. 2015;22(8):2532–9.

    Article  PubMed  Google Scholar 

  33. Williams KE, Barnes NL, Cramer A, et al. Molecular phenotypes of DCIS predict overall and invasive recurrence. Ann Oncol. 2015;26(5):1019–25.

    Article  CAS  PubMed  Google Scholar 

  34. Bryan BB, Schnitt SJ, Collins LC. Ductal carcinoma in situ with basal-like phenotype: a possible precursor to invasive basal-like breast cancer. Mod Pathol. 2006;19(5):617–21.

    Article  CAS  PubMed  Google Scholar 

  35. Dabbs DJ, Chivukula M, Carter G, Bhargava R. Basal phenotype of ductal carcinoma in situ: recognition and immunohistologic profile. Mod Pathol. 2006;19(11):1506–11.

    CAS  PubMed  Google Scholar 

  36. Lopez-Garcia MA, Geyer FC, Lacroix-Triki M, Marchio C, Reis-Filho JS. Breast cancer precursors revisited: molecular features and progression pathways. Histopathology. 2010;57(2):171–92.

    Article  PubMed  Google Scholar 

  37. Abdel-Fatah TM, Powe DG, Hodi Z, Reis-Filho JS, Lee AH, Ellis IO. Morphologic and molecular evolutionary pathways of low nuclear grade invasive breast cancers and their putative precursor lesions: further evidence to support the concept of low nuclear grade breast neoplasia family. Am J Surg Pathol. 2008;32(4):513–23.

    Article  PubMed  Google Scholar 

  38. Abdel-Fatah TM, Powe DG, Hodi Z, Lee AH, Reis-Filho JS, Ellis IO. High frequency of coexistence of columnar cell lesions, lobular neoplasia, and low grade ductal carcinoma in situ with invasive tubular carcinoma and invasive lobular carcinoma. Am J Surg Pathol. 2007;31(3):417–26.

    Article  PubMed  Google Scholar 

  39. Stratton MR, Collins N, Lakhani SR, Sloane JP. Loss of heterozygosity in ductal carcinoma in situ of the breast. J Pathol. 1995;175(2):195–201.

    Article  CAS  PubMed  Google Scholar 

  40. Buerger H, Otterbach F, Simon R, et al. Comparative genomic hybridization of ductal carcinoma in situ of the breast-evidence of multiple genetic pathways. J Pathol. 1999;187(4):396–402.

    Article  CAS  PubMed  Google Scholar 

  41. Gao Y, Niu Y, Wang X, Wei L, Lu S. Genetic changes at specific stages of breast cancer progression detected by comparative genomic hybridization. J Mol Med (Berl). 2009;87(2):145–52.

    Article  CAS  Google Scholar 

  42. Reis-Filho JS, Simpson PT, Gale T, Lakhani SR. The molecular genetics of breast cancer: the contribution of comparative genomic hybridization. Pathol Res Pract. 2005;201(11):713–25.

    Article  PubMed  Google Scholar 

  43. Simpson PT, Reis-Filho JS, Gale T, Lakhani SR. Molecular evolution of breast cancer. J Pathol. 2005;205(2):248–54.

    Article  CAS  PubMed  Google Scholar 

  44. Natrajan R, Lambros MB, Geyer FC, et al. Loss of 16q in high grade breast cancer is associated with estrogen receptor status: evidence for progression in tumors with a luminal phenotype? Genes Chromosomes Cancer. 2009;48(4):351–65.

    Article  CAS  PubMed  Google Scholar 

  45. Hernandez L, Wilkerson PM, Lambros MB, et al. Genomic and mutational profiling of ductal carcinomas in situ and matched adjacent invasive breast cancers reveals intra-tumour genetic heterogeneity and clonal selection. J Pathol. 2012;227(1):42–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Sagara Y, Mallory MA, Wong S, et al. Survival benefit of breast surgery for low-grade ductal carcinoma in situ: a population-based cohort study. JAMA Surg. 2015;150(8):739–45.

    Article  PubMed  Google Scholar 

  47. Group EBCC, Group ER, Bijker N, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853—a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol. 2006;24(21):3381–7.

    Article  Google Scholar 

  48. Fisher ER, Dignam J, Tan-Chiu E, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of protocol B-17: intraductal carcinoma. Cancer. 1999;86(3):429–38.

    Article  CAS  PubMed  Google Scholar 

  49. Hughes LL, Wang M, Page DL, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009;27(32):5319–24.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102(9):605–13.

    Article  PubMed  Google Scholar 

  51. Esserman LJ, Thompson IM, Reid B, et al. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncol. 2014;15(6):e234–42.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Sue GR, Chagpar AB. Predictors of recurrence in patients diagnosed with ductal carcinoma in situ. Am Surg. 2015;81(1):48–51.

    PubMed  Google Scholar 

  53. Benson JR, Wishart GC. Predictors of recurrence for ductal carcinoma in situ after breast-conserving surgery. Lancet Oncol. 2013;14(9):e348–57.

    Article  PubMed  Google Scholar 

  54. Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103(6):478–88.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Wang SY, Shamliyan T, Virnig BA, Kane R. Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Breast Cancer Res Treat. 2011;127(1):1–14.

    Article  CAS  PubMed  Google Scholar 

  56. Di Saverio S, Catena F, Santini D, et al. 259 patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up. Breast Cancer Res Treat. 2008;109(3):405–16.

    Article  PubMed  Google Scholar 

  57. Silverstein MJ, Lagios MD, Craig PH, et al. A prognostic index for ductal carcinoma in situ of the breast. Cancer. 1996;77(11):2267–74.

    Article  CAS  PubMed  Google Scholar 

  58. Solin LJ, Gray R, Baehner FL, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2013;105(10):701–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Wood WC, Alvarado M, Buchholz DJ, et al. The current clinical value of the DCIS Score. Oncology (Williston Park). 2014;28 Suppl 2:C2, 1–8, C3.

    Google Scholar 

  60. Jackman RJ, Birdwell RL, Ikeda DM. Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision? Radiology. 2002;224(2):548–54.

    Article  PubMed  Google Scholar 

  61. Maganini RO, Klem DA, Huston BJ, Bruner ES, Jacobs HK. Upgrade rate of core biopsy-determined atypical ductal hyperplasia by open excisional biopsy. Am J Surg. 2001;182(4):355–8.

    Article  CAS  PubMed  Google Scholar 

  62. Schnitt SJ, Connolly JL, Tavassoli FA, et al. Interobserver reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria. Am J Surg Pathol. 1992;16(12):1133–43.

    Article  CAS  PubMed  Google Scholar 

  63. Fitzgibbons PL, Henson DE, Hutter RV. Benign breast changes and the risk for subsequent breast cancer: an update of the 1985 consensus statement. Cancer Committee of the College of American Pathologists. Arch Pathol Lab Med. 1998;122(12):1053–5.

    CAS  PubMed  Google Scholar 

  64. Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med. 1985;312(3):146–51.

    Article  CAS  PubMed  Google Scholar 

  65. Hartmann LC, Degnim AC, Santen RJ, Dupont WD, Ghosh K. Atypical hyperplasia of the breast—risk assessment and management options. N Engl J Med. 2015;372(1):78–89.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  66. Page DL, Dupont WD, Rogers LW, Rados MS. Atypical hyperplastic lesions of the female breast. A long-term follow-up study. Cancer. 1985;55(11):2698–708.

    Article  CAS  PubMed  Google Scholar 

  67. Simpson J, Schnitt S, Visscher D, van der Vijver MJ, Ellis I. Atypical ductal hyperplasia. In: Lakhani S, Ellis IO, Schnitt SJ, Tan PH, van der Vijver MJ, editors. WHO classification of tumours of the breast. Lyon: IARC Press; 2012. p. 88–9.

    Google Scholar 

  68. Allison KH, Eby PR, Kohr J, DeMartini WB, Lehman CD. Atypical ductal hyperplasia on vacuum-assisted breast biopsy: suspicion for ductal carcinoma in situ can stratify patients at high risk for upgrade. Hum Pathol. 2011;42(1):41–50.

    Article  PubMed  Google Scholar 

  69. Eby PR, Ochsner JE, DeMartini WB, Allison KH, Peacock S, Lehman CD. Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum-assisted breast biopsy: 9-versus 11-gauge. AJR Am J Roentgenol. 2009;192(1):229–34.

    Article  PubMed  Google Scholar 

  70. Jain RK, Mehta R, Dimitrov R, et al. Atypical ductal hyperplasia: interobserver and intraobserver variability. Mod Pathol. 2011;24(7):917–23.

    Article  PubMed  Google Scholar 

  71. Lakhani SR, Collins N, Stratton MR, Sloane JP. Atypical ductal hyperplasia of the breast: clonal proliferation with loss of heterozygosity on chromosomes 16q and 17p. J Clin Pathol. 1995;48(7):611–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Larson PS, de las Morenas A, Cerda SR, Bennett SR, Cupples LA, Rosenberg CL. Quantitative analysis of allele imbalance supports atypical ductal hyperplasia lesions as direct breast cancer precursors. J Pathol. 2006;209(3):307–16.

    Article  CAS  PubMed  Google Scholar 

  73. Fuhrman GM, Cederbom GJ, Bolton JS, et al. Image-guided core-needle breast biopsy is an accurate technique to evaluate patients with nonpalpable imaging abnormalities. Ann Surg. 1998;227(6):932–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Jackman RJ, Nowels KW, Rodriguez-Soto J, Marzoni Jr FA, Finkelstein SI, Shepard MJ. Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology. 1999;210(3):799–805.

    Article  CAS  PubMed  Google Scholar 

  75. Jackman RJ, Nowels KW, Shepard MJ, Finkelstein SI, Marzoni Jr FA. Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia. Radiology. 1994;193(1):91–5.

    Article  CAS  PubMed  Google Scholar 

  76. Berg WA, Krebs TL, Campassi C, Magder LS, Sun CC. Evaluation of 14- and 11-gauge directional, vacuum-assisted biopsy probes and 14-gauge biopsy guns in a breast parenchymal model. Radiology. 1997;205(1):203–8.

    Article  CAS  PubMed  Google Scholar 

  77. Brown TA, Wall JW, Christensen ED, et al. Atypical hyperplasia in the era of stereotactic core needle biopsy. J Surg Oncol. 1998;67(3):168–73.

    Article  CAS  PubMed  Google Scholar 

  78. Burak Jr WE, Owens KE, Tighe MB, et al. Vacuum-assisted stereotactic breast biopsy: histologic underestimation of malignant lesions. Arch Surg. 2000;135(6):700–3.

    Article  PubMed  Google Scholar 

  79. Burbank F. Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted biopsy. Radiology. 1997;202(3):843–7.

    Article  CAS  PubMed  Google Scholar 

  80. Cangiarella J, Waisman J, Symmans WF, et al. Mammotome core biopsy for mammary microcalcification: analysis of 160 biopsies from 142 women with surgical and radiologic followup. Cancer. 2001;91(1):173–7.

    Article  CAS  PubMed  Google Scholar 

  81. Darling ML, Smith DN, Lester SC, et al. Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. AJR Am J Roentgenol. 2000;175(5):1341–6.

    Article  CAS  PubMed  Google Scholar 

  82. Doren E, Hulvat M, Norton J, et al. Predicting cancer on excision of atypical ductal hyperplasia. Am J Surg. 2008;195(3):358–61; discussion 61–2.

    Article  PubMed  Google Scholar 

  83. Elston CW, Sloane JP, Amendoeira I, et al. Causes of inconsistency in diagnosing and classifying intraductal proliferations of the breast. European Commission Working Group on Breast Screening Pathology. Eur J Cancer. 2000;36(14):1769–72.

    Article  CAS  PubMed  Google Scholar 

  84. Gadzala DE, Cederbom GJ, Bolton JS, et al. Appropriate management of atypical ductal hyperplasia diagnosed by stereotactic core needle breast biopsy. Ann Surg Oncol. 1997;4(4):283–6.

    Article  CAS  PubMed  Google Scholar 

  85. Houssami N, Ciatto S, Ellis I, Ambrogetti D. Underestimation of malignancy of breast core-needle biopsy: concepts and precise overall and category-specific estimates. Cancer. 2007;109(3):487–95.

    Article  PubMed  Google Scholar 

  86. Jacobs TW, Connolly JL, Schnitt SJ. Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? Am J Surg Pathol. 2002;26(9):1095–110.

    Article  PubMed  Google Scholar 

  87. Liberman L, Cohen MA, Dershaw DD, Abramson AF, Hann LE, Rosen PP. Atypical ductal hyperplasia diagnosed at stereotaxic core biopsy of breast lesions: an indication for surgical biopsy. AJR Am J Roentgenol. 1995;164(5):1111–3.

    Article  CAS  PubMed  Google Scholar 

  88. Liberman L, Dershaw DD, Glassman JR, et al. Analysis of cancers not diagnosed at stereotactic core breast biopsy. Radiology. 1997;203(1):151–7.

    Article  CAS  PubMed  Google Scholar 

  89. Liberman L, Kaplan JB, Morris EA, Abramson AF, Menell JH, Dershaw DD. To excise or to sample the mammographic target: what is the goal of stereotactic 11-gauge vacuum-assisted breast biopsy? AJR Am J Roentgenol. 2002;179(3):679–83.

    Article  PubMed  Google Scholar 

  90. Lin PH, Clyde JC, Bates DM, Garcia JM, Matsumoto GH, Girvin GW. Accuracy of stereotactic core-needle breast biopsy in atypical ductal hyperplasia. Am J Surg. 1998;175(5):380–2.

    Article  CAS  PubMed  Google Scholar 

  91. Lourenco AP, Mainiero MB, Lazarus E, Giri D, Schepps B. Stereotactic breast biopsy: comparison of histologic underestimation rates with 11- and 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol. 2007;189(5):W275–9.

    Article  PubMed  Google Scholar 

  92. Meyer JE, Smith DN, Lester SC, et al. Large-core needle biopsy of nonpalpable breast lesions. JAMA. 1999;281(17):1638–41.

    Article  CAS  PubMed  Google Scholar 

  93. Moore MM, Hargett 3rd CW, Hanks JB, et al. Association of breast cancer with the finding of atypical ductal hyperplasia at core breast biopsy. Ann Surg. 1997;225(6):726–31; discussion 31–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Nguyen M, McCombs MM, Ghandehari S, et al. An update on core needle biopsy for radiologically detected breast lesions. Cancer. 1996;78(11):2340–5.

    Article  CAS  PubMed  Google Scholar 

  95. Philpotts LE, Lee CH, Horvath LJ, Lange RC, Carter D, Tocino I. Underestimation of breast cancer with II-gauge vacuum suction biopsy. AJR Am J Roentgenol. 2000;175(4):1047–50.

    Article  CAS  PubMed  Google Scholar 

  96. Renshaw AA, Cartagena N, Schenkman RH, Derhagopian RP, Gould EW. Atypical ductal hyperplasia in breast core needle biopsies. Correlation of size of the lesion, complete removal of the lesion, and the incidence of carcinoma in follow-up biopsies. Am J Clin Pathol. 2001;116(1):92–6.

    Article  CAS  PubMed  Google Scholar 

  97. Tocino I, Garcia BM, Carter D. Surgical biopsy findings in patients with atypical hyperplasia diagnosed by stereotaxic core needle biopsy. Ann Surg Oncol. 1996;3(5):483–8.

    Article  CAS  PubMed  Google Scholar 

  98. Caplain A, Drouet Y, Peyron M, et al. Management of patients diagnosed with atypical ductal hyperplasia by vacuum-assisted core biopsy: a prospective assessment of the guidelines used at our institution. Am J Surg. 2014;208(2):260–7.

    Article  PubMed  Google Scholar 

  99. Hartmann LC, Radisky DC, Frost MH, et al. Understanding the premalignant potential of atypical hyperplasia through its natural history: a longitudinal cohort study. Cancer Prev Res (Phila). 2014;7(2):211–7.

    Article  CAS  Google Scholar 

  100. Page DL, Dupont WD. Benign breast disease: indicators of increased breast cancer risk. Cancer Detect Prev. 1992;16(2):93–7.

    CAS  PubMed  Google Scholar 

  101. Reis-Filho JS, Lakhani SR. The diagnosis and management of pre-invasive breast disease: genetic alterations in pre-invasive lesions. Breast Cancer Res. 2003;5(6):313–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  102. Ellis IO, Pinder SE, Lee AH, Elston CW. A critical appraisal of existing classification systems of epithelial hyperplasia and in situ neoplasia of the breast with proposals for future methods of categorization: where are we going? Semin Diagn Pathol. 1999;16(3):202–8.

    CAS  PubMed  Google Scholar 

  103. Shaaban AM, Sloane JP, West CR, Foster CS. Breast cancer risk in usual ductal hyperplasia is defined by estrogen receptor-alpha and Ki-67 expression. Am J Pathol. 2002;160(2):597–604.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Boecker W, Buerger H, Schmitz K, et al. Ductal epithelial proliferations of the breast: a biological continuum? Comparative genomic hybridization and high-molecular-weight cytokeratin expression patterns. J Pathol. 2001;195(4):415–21.

    Article  CAS  PubMed  Google Scholar 

  105. Shoker BS, Jarvis C, Clarke RB, et al. Estrogen receptor-positive proliferating cells in the normal and precancerous breast. Am J Pathol. 1999;155(6):1811–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  106. Shekhar MP, Nangia-Makker P, Wolman SR, Tait L, Heppner GH, Visscher DW. Direct action of estrogen on sequence of progression of human preneoplastic breast disease. Am J Pathol. 1998;152(5):1129–32.

    CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology, Stanford University School of Medicine, 300 Pasteur Dr., Lane 235, Stanford, CA, 94305, USA

    Kimberly H. Allison M.D. & Kristin C. Jensen M.D.

  2. Pathology and Laboratory Medicine Service, Veteran Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Building 100, Room E4-332, Palo Alto, CA, 94304, USA

    Kristin C. Jensen M.D.

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  1. Kimberly H. Allison M.D.
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Correspondence to Kimberly H. Allison M.D. .

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Editors and Affiliations

  1. New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA

    Sandra J. Shin

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Allison, K.H., Jensen, K.C. (2016). Intraductal Proliferations (DCIS, ADH, and UDH). In: Shin, S. (eds) A Comprehensive Guide to Core Needle Biopsies of the Breast . Springer, Cham. https://doi.org/10.1007/978-3-319-26291-8_9

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