The current dogma in the breast community is that a patient with a diagnosis of atypical ductal hyperplasia (ADH) on needle core biopsy needs to have that area removed surgically.  This is because most studies showed that in about 20-30% of the time a more significant lesion was seen on the surgical excision, such as carcinoma in situ or invasive carcinoma. However, there have been several studies over the past few years including one just last month in the American Journal of Surgery that is questioning this concept.

A study done several years ago suggested that if pathologists quantified the amount of ADH on a core biopsy, then cases in which only a few ducts had ADH (meaning a very small area), then nothing worse was found on surgical excision. Other studies followed and had similar results, including one a colleague of mine and I performed as well as this most recent study from France.  To be fair, some studies have shown just the opposite finding and still recommend surgical excision for all ADH no matter how focal. This is why more studies need to be done that have larger numbers of patients and that are standardized with regard to pathology and imaging review.

I think this is a promising start.  The goal is to find a subset of patients who have very small foci of ADH on their core biopsy and where the radiologist and pathologist can agree that the calcifications were removed and are associated with the ADH.  Perhaps this group of patients can then be followed by breast imaging and they would not require surgical excision.

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