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Atypical Ductal Hyperplasia
Lauren Q. Chang Sen, MD; Marion E. Scoggins, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Atypical ductal hyperplasia (ADH)
            • Definitions

              • Intraductal epithelial proliferative lesion that meets some, but not all, criteria for low-grade DCIS
                • Cells not monomorphic: Partial streaming of cells or some columnar cells; duct lumina filled or secondary spaces uniform, punched out, "cookie cutter," or
                • Cells uniform in size and shape, but only partially fill duct lumen or lack uniform secondary spaces, or
                • Process involves only 1 duct profile or ≤ 2 mm in aggregate size
                • > 90% of ADH lacks CK5 retained in usual ductal hyperplasia (UDH)
              • Low-grade DCIS: Monomorphic cells; duct lumina filled or secondary spaces uniform; at least 2 mm aggregate size (2 duct profiles) or 3 mm if involving papilloma
              • Atypical papilloma: Papilloma involved by ADH; cytologic atypia insufficient

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Image-Guided Biopsy

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Rageth CJ et al: Atypical ductal hyperplasia and the risk of underestimation: tissue sampling method, multifocality, and associated calcification significantly influence the diagnostic upgrade rate based on subsequent surgical specimens. Breast Cancer. ePub, 2018
                                          2. Calhoun BC: Core needle biopsy of the breast: An evaluation of contemporary data. Surg Pathol Clin. 11(1):1-16, 2018
                                          3. Co M et al: Factors affecting the under-diagnosis of atypical ductal hyperplasia diagnosed by core needle biopsies - A 10-year retrospective study and review of the literature. Int J Surg. 49:27-31, 2018
                                          4. Collins LC: Precursor lesions of the low-grade breast neoplasia pathway. Surg Pathol Clin. 11(1):177-197, 2018
                                          5. Lamb LR et al: Pathologic upgrade rates of high-risk breast lesions on digital two-dimensional vs tomosynthesis mammography. J Am Coll Surg. 226(5):858-867, 2018
                                          6. Monticciolo DL et al: Breast Cancer Screening in Women at Higher-Than-Average Risk: Recommendations From the ACR. J Am Coll Radiol. 15(3 Pt A):408-414, 2018
                                          7. Oligane HC et al: Grouped Amorphous Calcifications at Mammography: Frequently Atypical but Rarely Associated with Aggressive Malignancy. Radiology. 172406, 2018
                                          8. Kader T et al: Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape. Breast Cancer Res. 20(1):39, 2018
                                          9. Latronico A et al: Atypical ductal hyperplasia: Our experience in the management and long term clinical follow-up in 71 patients. Breast. 37:1-5, 2018
                                          10. Linsk A et al: Surgical upgrade rate of breast atypia to malignancy: An academic center's experience and validation of a predictive model. Breast J. 24(2):115-119, 2018
                                          11. Racz JM et al: When Does Atypical Ductal Hyperplasia Require Surgical Excision? Surg Oncol Clin N Am. 27(1):23-32, 2018
                                          12. Speer ME et al: High risk breast lesions identified on MRI-guided vacuum-assisted needle biopsy: outcome of surgical excision and imaging follow-up. Br J Radiol. 20180300, 2018
                                          13. Menen RS et al: Long-Term Safety of Observation in Selected Women Following Core Biopsy Diagnosis of Atypical Ductal Hyperplasia. Ann Surg Oncol. 24(1):70-76, 2017
                                          14. Menes TS et al: Subsequent Breast Cancer Risk Following Diagnosis of Atypical Ductal Hyperplasia on Needle Biopsy. JAMA Oncol. 3(1):36-41, 2017
                                          15. Peña A et al: Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia. Breast Cancer Res Treat. 164(2):295-304, 2017
                                          16. Ahn HS et al: Diagnosis of Columnar Cell Lesions and Atypical Ductal Hyperplasia by Ultrasound-Guided Core Biopsy: Findings Associated with Underestimation of Breast Carcinoma. Ultrasound Med Biol. 42(7):1457-63, 2016
                                          17. Badan GM et al: Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution. Radiol Bras. 49(1):6-11, 2016
                                          18. Collins LC et al: Breast cancer risk by extent and type of atypical hyperplasia: An update from the Nurses' Health Studies. Cancer. 122(4):515-20, 2016
                                          19. Degnim AC et al: Extent of atypical hyperplasia stratifies breast cancer risk in 2 independent cohorts of women. Cancer. 122(19):2971-8, 2016
                                          20. Khoury T et al: The risk of upgrade for atypical ductal hyperplasia detected on magnetic resonance imaging-guided biopsy: a study of 100 cases from four academic institutions. Histopathology. 68(5):713-21, 2016
                                          21. Murray M: Pathologic High-risk Lesions, Diagnosis and Management. Clin Obstet Gynecol. 59(4):727-732, 2016
                                          22. Rageth CJ et al: First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 159(2):203-13, 2016
                                          23. Renshaw AA et al: Long term clinical follow-up of atypical ductal hyperplasia and lobular carcinoma in situ in breast core needle biopsies. Pathology. 48(1):25-9, 2016
                                          24. Verheyden C et al: Underestimation Rate at MR Imaging-guided Vacuum-assisted Breast Biopsy: A Multi-Institutional Retrospective Study of 1509 Breast Biopsies. Radiology. 281(3):708-719, 2016
                                          25. Elmore JG et al: Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 313(11):1122-32, 2015
                                          26. Hartmann LC et al: Atypical hyperplasia of the breast. N Engl J Med. 372(13):1271-2, 2015
                                          27. Khoury T et al: Nomogram to predict the likelihood of upgrade of atypical ductal hyperplasia diagnosed on a core needle biopsy in mammographically detected lesions. Histopathology. 67(1):106-20, 2015
                                          28. Visscher DW et al: Clinicopathologic features of breast cancers that develop in women with previous benign breast disease. Cancer. ePub, 2015
                                          29. Weinfurtner RJ et al: Magnetic resonance imaging-guided core needle breast biopsies resulting in high-risk histopathologic findings: upstage frequency and lesion characteristics. Clin Breast Cancer. 15(3):234-9, 2015
                                          30. Wells JM et al: Elucidating encounters of atypical ductal hyperplasia arising in gynaecomastia. Histopathology. 66(3):398-408, 2015
                                          31. Yu CC et al: Predictors of underestimation of malignancy after image-guided core needle biopsy diagnosis of flat epithelial atypia or atypical ductal hyperplasia. Breast J. 21(3):224-32, 2015
                                          32. Li Z et al: Incidental atypical proliferative lesions in reduction mammoplasty specimens in patients with a history of breast cancer. Hum Pathol. 45(1):104-9, 2014
                                          33. McLaughlin CT et al: Is the upgrade rate of atypical ductal hyperplasia diagnosed by core needle biopsy of calcifications different for digital and film-screen mammography? AJR Am J Roentgenol. 203(4):917-22, 2014
                                          34. Menes TS et al: Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium. Am J Surg. 207(1):24-31, 2014
                                          35. Mesurolle B et al: Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation. AJR Am J Roentgenol. 202(6):1389-94, 2014
                                          36. Youn I et al: Absence of Residual Microcalcifications in Atypical Ductal Hyperplasia Diagnosed via Stereotactic Vacuum-Assisted Breast Biopsy: Is Surgical Excision Obviated? J Breast Cancer. 17(3):265-9, 2014
                                          37. Desouki MM et al: Incidental atypical proliferative lesions in reduction mammoplasty specimens: analysis of 2498 cases from 2 tertiary women's health centers. Hum Pathol. 44(9):1877-81, 2013
                                          38. Coopey SB et al: The role of chemoprevention in modifying the risk of breast cancer in women with atypical breast lesions. Breast Cancer Res Treat. 136(3):627-33, 2012
                                          39. Heller SL et al: Imaging features and management of high-risk lesions on contrast-enhanced dynamic breast MRI. AJR Am J Roentgenol. 198(2):249-55, 2012
                                          40. Hsu HH et al: Atypical ductal hyperplasia of the breast diagnosed by ultrasonographically guided core needle biopsy. Ultraschall Med. 33(5):447-54, 2012
                                          41. Linda A et al: Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? AJR Am J Roentgenol. 198(2):272-80, 2012
                                          42. McGhan LJ et al: Atypical ductal hyperplasia on core biopsy: an automatic trigger for excisional biopsy? Ann Surg Oncol. 19(10):3264-9, 2012
                                          43. Rauch GM et al: Outcome analysis of 9-gauge MRI-guided vacuum-assisted core needle breast biopsies. AJR Am J Roentgenol. 198(2):292-9, 2012
                                          44. Allison KH et al: Atypical ductal hyperplasia on vacuum-assisted breast biopsy: suspicion for ductal carcinoma in situ can stratify patients at high risk for upgrade. Hum Pathol. 42(1):41-50, 2011
                                          45. Crystal P et al: High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted? Eur Radiol. 21(3):582-9, 2011
                                          46. Londero V et al: Borderline breast lesions: comparison of malignancy underestimation rates with 14-gauge core needle biopsy versus 11-gauge vacuum-assisted device. Eur Radiol. 21(6):1200-6, 2011
                                          47. Masood S et al: Borderline breast lesions: diagnostic challenges and clinical implications. Adv Anat Pathol. 18(3):190-8, 2011
                                          48. Villa A et al: Atypical ductal hyperplasia diagnosed at 11-gauge vacuum-assisted breast biopsy performed on suspicious clustered microcalcifications: could patients without residual microcalcifications be managed conservatively? AJR Am J Roentgenol. 197(4):1012-8, 2011
                                          49. Bruening W et al: Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Ann Intern Med. 152(4):238-46, 2010
                                          50. Ellis IO: Intraductal proliferative lesions of the breast: morphology, associated risk and molecular biology. Mod Pathol. 23 Suppl 2:S1-7, 2010
                                          51. Kohr JR et al: Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. Radiology. 255(3):723-30, 2010
                                          52. Mao X et al: Genetic mutations and expression of p53 in non-invasive breast lesions. Mol Med Report. 3(6):929-34, 2010
                                          53. Pediconi F et al: Role of breast MR imaging for predicting malignancy of histologically borderline lesions diagnosed at core needle biopsy: prospective evaluation. Radiology. 257(3):653-61, 2010
                                          54. Penco S et al: Stereotactic vacuum-assisted breast biopsy is not a therapeutic procedure even when all mammographically found calcifications are removed: analysis of 4,086 procedures. AJR Am J Roentgenol. 195(5):1255-60, 2010
                                          55. Sickles EA: The use of breast imaging to screen women at high risk for cancer. Radiol Clin North Am. 48(5):859-78, 2010
                                          56. Strigel RM et al: Frequency, upgrade rates, and characteristics of high-risk lesions initially identified with breast MRI. AJR Am J Roentgenol. 195(3):792-8, 2010
                                          57. Eby PR et al: Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum-assisted breast biopsy: 9-versus 11-gauge. AJR Am J Roentgenol. 192(1):229-34, 2009
                                          58. Youk JH et al: Atypical ductal hyperplasia diagnosed at sonographically guided 14-gauge core needle biopsy of breast mass. AJR Am J Roentgenol. 192(4):1135-41, 2009
                                          59. Arora S et al: Atypical ductal hyperplasia at margin of breast biopsy--is re-excision indicated? Ann Surg Oncol. 15(3):843-7, 2008
                                          60. Eby PR et al: Is surgical excision necessary for focal atypical ductal hyperplasia found at stereotactic vacuum-assisted breast biopsy? Ann Surg Oncol. 15(11):3232-8, 2008
                                          61. Liberman L et al: Underestimation of atypical ductal hyperplasia at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol. 188(3):684-90, 2007
                                          62. Sohn V et al: Atypical ductal hyperplasia: improved accuracy with the 11-gauge vacuum-assisted versus the 14-gauge core biopsy needle. Ann Surg Oncol. 14(9):2497-501, 2007
                                          63. Greene T et al: The significance of surgical margins for patients with atypical ductal hyperplasia. Am J Surg. 192(4):499-501, 2006
                                          64. Hoogerbrugge N et al: Numerous high-risk epithelial lesions in familial breast cancer. Eur J Cancer. 2006
                                          65. Vogel VG et al: Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA. 295(23):2727-41, 2006
                                          66. Grady I et al: Ultrasound-guided, vacuum-assisted, percutaneous excision of breast lesions: an accurate technique in the diagnosis of atypical ductal hyperplasia. J Am Coll Surg. 201(1):14-7, 2005
                                          67. Ho BC et al: Flat epithelial atypia: concepts and controversies of an intraductal lesion of the breast. Pathology. 37(2):105-11, 2005
                                          68. Prasad V et al: Bilateral atypical ductal hyperplasia, an incidental finding in gynaecomastia--case report and literature review. Breast. 14(4):317-21, 2005
                                          69. Berg WA: Image-guided breast biopsy and management of high-risk lesions. Radiol Clin North Am. 42(5):935-46, vii, 2004
                                          70. Goldflam K et al: Contralateral prophylactic mastectomy. Predictors of significant histologic findings. Cancer. 101(9):1977-86, 2004
                                          71. Liberman L et al: Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol. 181(2):519-25, 2003
                                          72. Jackman RJ et al: 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. 224(2):548-54, 2002
                                          73. Liberman L et al: To excise or to sample the mammographic target: what is the goal of stereotactic 11-gauge vacuum-assisted breast biopsy? AJR Am J Roentgenol. 179(3):679-83, 2002
                                          74. Berg WA et al: Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology. 221(2):495-503, 2001
                                          75. Carter BA et al: No elevation in long-term breast carcinoma risk for women with fibroadenomas that contain atypical hyperplasia. Cancer. 92(1):30-6, 2001
                                          76. Ely KA et al: Core biopsy of the breast with atypical ductal hyperplasia: a probabilistic approach to reporting. Am J Surg Pathol. 25(8):1017-21, 2001
                                          77. Fisher B et al: Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 90(18):1371-88, 1998
                                          78. Page DL et al: Premalignant and malignant disease of the breast: the roles of the pathologist. Mod Pathol. 11(2):120-8, 1998
                                          79. Page DL et al: Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer. 78(2):258-66, 1996
                                          80. Dupont WD et al: Breast cancer risk associated with proliferative breast disease and atypical hyperplasia. Cancer. 71(4):1258-65, 1993
                                          81. Stomper PC et al: Atypical hyperplasia: frequency and mammographic and pathologic relationships in excisional biopsies guided with mammography and clinical examination. Radiology. 189(3):667-71, 1993
                                          82. Schnitt SJ et al: Interobserver reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria. Am J Surg Pathol. 16(12):1133-43, 1992
                                          83. Page DL et al: Atypical hyperplastic lesions of the female breast. A long-term follow-up study. Cancer. 55(11):2698-708, 1985
                                          84. Andersen JA et al: Male breast at autopsy. Acta Pathol Microbiol Immunol Scand A. 90(3):191-7, 1982
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Atypical ductal hyperplasia (ADH)
                                                    • Definitions

                                                      • Intraductal epithelial proliferative lesion that meets some, but not all, criteria for low-grade DCIS
                                                        • Cells not monomorphic: Partial streaming of cells or some columnar cells; duct lumina filled or secondary spaces uniform, punched out, "cookie cutter," or
                                                        • Cells uniform in size and shape, but only partially fill duct lumen or lack uniform secondary spaces, or
                                                        • Process involves only 1 duct profile or ≤ 2 mm in aggregate size
                                                        • > 90% of ADH lacks CK5 retained in usual ductal hyperplasia (UDH)
                                                      • Low-grade DCIS: Monomorphic cells; duct lumina filled or secondary spaces uniform; at least 2 mm aggregate size (2 duct profiles) or 3 mm if involving papilloma
                                                      • Atypical papilloma: Papilloma involved by ADH; cytologic atypia insufficient

                                                    IMAGING

                                                    • General Features

                                                      • Mammographic Findings

                                                        • Ultrasonographic Findings

                                                          • MR Findings

                                                            • Image-Guided Biopsy

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Rageth CJ et al: Atypical ductal hyperplasia and the risk of underestimation: tissue sampling method, multifocality, and associated calcification significantly influence the diagnostic upgrade rate based on subsequent surgical specimens. Breast Cancer. ePub, 2018
                                                                                  2. Calhoun BC: Core needle biopsy of the breast: An evaluation of contemporary data. Surg Pathol Clin. 11(1):1-16, 2018
                                                                                  3. Co M et al: Factors affecting the under-diagnosis of atypical ductal hyperplasia diagnosed by core needle biopsies - A 10-year retrospective study and review of the literature. Int J Surg. 49:27-31, 2018
                                                                                  4. Collins LC: Precursor lesions of the low-grade breast neoplasia pathway. Surg Pathol Clin. 11(1):177-197, 2018
                                                                                  5. Lamb LR et al: Pathologic upgrade rates of high-risk breast lesions on digital two-dimensional vs tomosynthesis mammography. J Am Coll Surg. 226(5):858-867, 2018
                                                                                  6. Monticciolo DL et al: Breast Cancer Screening in Women at Higher-Than-Average Risk: Recommendations From the ACR. J Am Coll Radiol. 15(3 Pt A):408-414, 2018
                                                                                  7. Oligane HC et al: Grouped Amorphous Calcifications at Mammography: Frequently Atypical but Rarely Associated with Aggressive Malignancy. Radiology. 172406, 2018
                                                                                  8. Kader T et al: Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape. Breast Cancer Res. 20(1):39, 2018
                                                                                  9. Latronico A et al: Atypical ductal hyperplasia: Our experience in the management and long term clinical follow-up in 71 patients. Breast. 37:1-5, 2018
                                                                                  10. Linsk A et al: Surgical upgrade rate of breast atypia to malignancy: An academic center's experience and validation of a predictive model. Breast J. 24(2):115-119, 2018
                                                                                  11. Racz JM et al: When Does Atypical Ductal Hyperplasia Require Surgical Excision? Surg Oncol Clin N Am. 27(1):23-32, 2018
                                                                                  12. Speer ME et al: High risk breast lesions identified on MRI-guided vacuum-assisted needle biopsy: outcome of surgical excision and imaging follow-up. Br J Radiol. 20180300, 2018
                                                                                  13. Menen RS et al: Long-Term Safety of Observation in Selected Women Following Core Biopsy Diagnosis of Atypical Ductal Hyperplasia. Ann Surg Oncol. 24(1):70-76, 2017
                                                                                  14. Menes TS et al: Subsequent Breast Cancer Risk Following Diagnosis of Atypical Ductal Hyperplasia on Needle Biopsy. JAMA Oncol. 3(1):36-41, 2017
                                                                                  15. Peña A et al: Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia. Breast Cancer Res Treat. 164(2):295-304, 2017
                                                                                  16. Ahn HS et al: Diagnosis of Columnar Cell Lesions and Atypical Ductal Hyperplasia by Ultrasound-Guided Core Biopsy: Findings Associated with Underestimation of Breast Carcinoma. Ultrasound Med Biol. 42(7):1457-63, 2016
                                                                                  17. Badan GM et al: Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution. Radiol Bras. 49(1):6-11, 2016
                                                                                  18. Collins LC et al: Breast cancer risk by extent and type of atypical hyperplasia: An update from the Nurses' Health Studies. Cancer. 122(4):515-20, 2016
                                                                                  19. Degnim AC et al: Extent of atypical hyperplasia stratifies breast cancer risk in 2 independent cohorts of women. Cancer. 122(19):2971-8, 2016
                                                                                  20. Khoury T et al: The risk of upgrade for atypical ductal hyperplasia detected on magnetic resonance imaging-guided biopsy: a study of 100 cases from four academic institutions. Histopathology. 68(5):713-21, 2016
                                                                                  21. Murray M: Pathologic High-risk Lesions, Diagnosis and Management. Clin Obstet Gynecol. 59(4):727-732, 2016
                                                                                  22. Rageth CJ et al: First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 159(2):203-13, 2016
                                                                                  23. Renshaw AA et al: Long term clinical follow-up of atypical ductal hyperplasia and lobular carcinoma in situ in breast core needle biopsies. Pathology. 48(1):25-9, 2016
                                                                                  24. Verheyden C et al: Underestimation Rate at MR Imaging-guided Vacuum-assisted Breast Biopsy: A Multi-Institutional Retrospective Study of 1509 Breast Biopsies. Radiology. 281(3):708-719, 2016
                                                                                  25. Elmore JG et al: Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 313(11):1122-32, 2015
                                                                                  26. Hartmann LC et al: Atypical hyperplasia of the breast. N Engl J Med. 372(13):1271-2, 2015
                                                                                  27. Khoury T et al: Nomogram to predict the likelihood of upgrade of atypical ductal hyperplasia diagnosed on a core needle biopsy in mammographically detected lesions. Histopathology. 67(1):106-20, 2015
                                                                                  28. Visscher DW et al: Clinicopathologic features of breast cancers that develop in women with previous benign breast disease. Cancer. ePub, 2015
                                                                                  29. Weinfurtner RJ et al: Magnetic resonance imaging-guided core needle breast biopsies resulting in high-risk histopathologic findings: upstage frequency and lesion characteristics. Clin Breast Cancer. 15(3):234-9, 2015
                                                                                  30. Wells JM et al: Elucidating encounters of atypical ductal hyperplasia arising in gynaecomastia. Histopathology. 66(3):398-408, 2015
                                                                                  31. Yu CC et al: Predictors of underestimation of malignancy after image-guided core needle biopsy diagnosis of flat epithelial atypia or atypical ductal hyperplasia. Breast J. 21(3):224-32, 2015
                                                                                  32. Li Z et al: Incidental atypical proliferative lesions in reduction mammoplasty specimens in patients with a history of breast cancer. Hum Pathol. 45(1):104-9, 2014
                                                                                  33. McLaughlin CT et al: Is the upgrade rate of atypical ductal hyperplasia diagnosed by core needle biopsy of calcifications different for digital and film-screen mammography? AJR Am J Roentgenol. 203(4):917-22, 2014
                                                                                  34. Menes TS et al: Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium. Am J Surg. 207(1):24-31, 2014
                                                                                  35. Mesurolle B et al: Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation. AJR Am J Roentgenol. 202(6):1389-94, 2014
                                                                                  36. Youn I et al: Absence of Residual Microcalcifications in Atypical Ductal Hyperplasia Diagnosed via Stereotactic Vacuum-Assisted Breast Biopsy: Is Surgical Excision Obviated? J Breast Cancer. 17(3):265-9, 2014
                                                                                  37. Desouki MM et al: Incidental atypical proliferative lesions in reduction mammoplasty specimens: analysis of 2498 cases from 2 tertiary women's health centers. Hum Pathol. 44(9):1877-81, 2013
                                                                                  38. Coopey SB et al: The role of chemoprevention in modifying the risk of breast cancer in women with atypical breast lesions. Breast Cancer Res Treat. 136(3):627-33, 2012
                                                                                  39. Heller SL et al: Imaging features and management of high-risk lesions on contrast-enhanced dynamic breast MRI. AJR Am J Roentgenol. 198(2):249-55, 2012
                                                                                  40. Hsu HH et al: Atypical ductal hyperplasia of the breast diagnosed by ultrasonographically guided core needle biopsy. Ultraschall Med. 33(5):447-54, 2012
                                                                                  41. Linda A et al: Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? AJR Am J Roentgenol. 198(2):272-80, 2012
                                                                                  42. McGhan LJ et al: Atypical ductal hyperplasia on core biopsy: an automatic trigger for excisional biopsy? Ann Surg Oncol. 19(10):3264-9, 2012
                                                                                  43. Rauch GM et al: Outcome analysis of 9-gauge MRI-guided vacuum-assisted core needle breast biopsies. AJR Am J Roentgenol. 198(2):292-9, 2012
                                                                                  44. Allison KH et al: Atypical ductal hyperplasia on vacuum-assisted breast biopsy: suspicion for ductal carcinoma in situ can stratify patients at high risk for upgrade. Hum Pathol. 42(1):41-50, 2011
                                                                                  45. Crystal P et al: High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted? Eur Radiol. 21(3):582-9, 2011
                                                                                  46. Londero V et al: Borderline breast lesions: comparison of malignancy underestimation rates with 14-gauge core needle biopsy versus 11-gauge vacuum-assisted device. Eur Radiol. 21(6):1200-6, 2011
                                                                                  47. Masood S et al: Borderline breast lesions: diagnostic challenges and clinical implications. Adv Anat Pathol. 18(3):190-8, 2011
                                                                                  48. Villa A et al: Atypical ductal hyperplasia diagnosed at 11-gauge vacuum-assisted breast biopsy performed on suspicious clustered microcalcifications: could patients without residual microcalcifications be managed conservatively? AJR Am J Roentgenol. 197(4):1012-8, 2011
                                                                                  49. Bruening W et al: Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Ann Intern Med. 152(4):238-46, 2010
                                                                                  50. Ellis IO: Intraductal proliferative lesions of the breast: morphology, associated risk and molecular biology. Mod Pathol. 23 Suppl 2:S1-7, 2010
                                                                                  51. Kohr JR et al: Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. Radiology. 255(3):723-30, 2010
                                                                                  52. Mao X et al: Genetic mutations and expression of p53 in non-invasive breast lesions. Mol Med Report. 3(6):929-34, 2010
                                                                                  53. Pediconi F et al: Role of breast MR imaging for predicting malignancy of histologically borderline lesions diagnosed at core needle biopsy: prospective evaluation. Radiology. 257(3):653-61, 2010
                                                                                  54. Penco S et al: Stereotactic vacuum-assisted breast biopsy is not a therapeutic procedure even when all mammographically found calcifications are removed: analysis of 4,086 procedures. AJR Am J Roentgenol. 195(5):1255-60, 2010
                                                                                  55. Sickles EA: The use of breast imaging to screen women at high risk for cancer. Radiol Clin North Am. 48(5):859-78, 2010
                                                                                  56. Strigel RM et al: Frequency, upgrade rates, and characteristics of high-risk lesions initially identified with breast MRI. AJR Am J Roentgenol. 195(3):792-8, 2010
                                                                                  57. Eby PR et al: Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum-assisted breast biopsy: 9-versus 11-gauge. AJR Am J Roentgenol. 192(1):229-34, 2009
                                                                                  58. Youk JH et al: Atypical ductal hyperplasia diagnosed at sonographically guided 14-gauge core needle biopsy of breast mass. AJR Am J Roentgenol. 192(4):1135-41, 2009
                                                                                  59. Arora S et al: Atypical ductal hyperplasia at margin of breast biopsy--is re-excision indicated? Ann Surg Oncol. 15(3):843-7, 2008
                                                                                  60. Eby PR et al: Is surgical excision necessary for focal atypical ductal hyperplasia found at stereotactic vacuum-assisted breast biopsy? Ann Surg Oncol. 15(11):3232-8, 2008
                                                                                  61. Liberman L et al: Underestimation of atypical ductal hyperplasia at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol. 188(3):684-90, 2007
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