Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy

Abstract

Background The aim of this study was to determine factors that predict under-evaluation of malignancy in patients diagnosed with atypical ductal hyperplasia (ADH) at ultrasound-guided core needle biopsy (CNB), and to develop a prediction algorithm for scoring the possibility of a diagnosis upgrade to malignancy based on clinical, radiological and pathological factors. Methods The study enrolled patients diagnosed with ADH at ultrasound-guided CNB who subsequently underwent surgical excision of the lesion. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy. Results A total of 102 patients with ADH at CNB were identified. Of the 74 patients who underwent subsequent surgical excision, 34 (45.8%) were diagnosed with invasive or in situ malignant foci. Multivariate analysis revealed that age [50 years, microcalcification on mammography, size on imaging [15 mm and a palpable lesion were independent predictors of malignancy. Focal ADH was a negative predictor. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.903 (95% CI: 0.82-0.94), and the negative predictive value was 100% for a score B3.5. Similar findings were observed for a validation dataset of 54 patients at other institutions. Conclusions A scoring system to predict malignancy in patients diagnosed with ADH at CNB was developed based on five factors: age, palpable lesion, microcalcification on mammography, size on imaging and focal ADH. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate.

Validation of a Scoring System for Predicting Malignancy in Patients Diagnosed with Atypical Ductal Hyperplasia Using an Ultrasound-Guided Core Needle Biopsy

“…Patients who underwent CNB in other institutions were excluded due to the absence of information such as initial image findings and the gauge of the needle used. We have previously reported on our scoring system for predicting malignancy in CNB-diagnosed ADH [1], which is based on values given to five clinicopathological factors of age, palpability, microcalcification, size of lesion, and multiplicity [U score= 3.5×age (age ≤50=0, age >50 =1)+2.0×palpability (non-palpable=0, palpable=1)+2.0×microcalcification (no=0, yes=1)+3.5×sonographic size (≤1.5 cm=0, >1.5 cm=1)+ 3.5×multiplicity (focal=0, multiple=1)]. The constant of each variable was derived from the logistic regression model as previously described [1].…”

“…Ultrasound-guided core needle biopsy (CNB) has become an alternative to surgical biopsy as a primary diagnostic modality because of its accuracy and cost-effectiveness [1]. Its other advantages include that there is no requirement for ionizing radiation, non-dedicated equipment can be used, and real-time visualization of the biopsy needle is possible [2].…”

“…However, it may be possible to avoid surgical excision if clinicians are able to identify lesions with a low probability of harboring malignant foci. Therefore, we previously developed a scoring system for predicting malignancy in CNB-diagnosed ADH [1,5]. The score takes into account patient age, palpability, microcalcification, lesion size, and multiplicity.…”

Poster

“…1 However, up to 44% of cases will be upstaged to invasive carcinoma after surgical excision due to the highly targeted nature of core needle biopsy. [2][3][4] This will subject the patient for another operation for the staging of the axilla. The aim of this study is to review and identify possible predictive factors of upstaging ductal carcinoma in situ to invasive carcinoma after surgical excision to avoid additional risk of general anaesthesia.…”

US-guided 14G Core Needle Biopsy: Comparison Between Underestimated and Correctly Diagnosed Breast Cancers

“…There has been several studies about correlation with underestimation rate and clinical condition or radiologic findings such as Breast US or mammogram. Some study was evaluated to develop a scoring system for prediction of ADH underestimation at sonographically guided CNB (Ko et al, 2008). Sonographic BI-RADS final assessment categories were not significantly associated with underestimation, but detailed sonographic features according to the BI-RADS lexicon were not analyzed.…”