Atypical Ductal Hyperplasia of the Breast
Clinical
- Atypical ductal hyperplasia is considered a marker of increased risk of carcinoma rather than a precursor lesion
- Its presence in a core biopsy is an indication for excisional biopsy
- In an excisional biopsy, margins are not relevant if it is the only lesion
- If the excision is for DCIS or invasive carcinoma and ADH is at the margin it is probably best to suggest re-excision
Relative risk for development of invasive breast carcinoma
- No increased risk
- Non-proliferative fibrocystic change
- Fibroadenoma
- Solitary papilloma
- Slightly increased risk (1.5 to 2 times)
- Proliferative fibrocystic change
- Usual ductal hyperplasia
- Sclerosing adenosis (florid)
- Radial scar
- Complex fibroadenoma (approximately 3 times risk)
- Moderately increased risk (4 to 5 times)
- Atypical ductal hyperplasia (no family history)
- Atypical lobular hyperplasia
- High risk (8 to 10 times)
- Ductal carcinoma in situ, low grade
- Lobular carcinoma in situ
- Atypical ductal hyperplasia, if history of carcinoma in primary relatives
- Very high risk (precise level not known)
- Ductal carcinoma in situ, high grade
