Practical point

There are some situations where atypia is noted, but other factors preclude a diagnosis of FEA, ADH, or DCIS.

E.g. Very few cells, fragmented specimen, only in lobules.

May use something along the lines of: Epithelial proliferation with atypia, see comment.

Results in close follow-up, re-core, excision, depending on clinical/radiographic setting.

CCC

FEA

Risks and management

UDH ADH LG DCIS FEARR of IDC 1.5x 3-5x 8-10x Less than

ADHUpgrade rate to DCIS on excision

N/A 15-50%* N/A 25-40% **

Management Nil Excise Excise +/- radiation

Excise

Type of risk Indicator, bilateral

Indicator, bilateral

Precursor Indicator

** Limited data and wide variation in reported upgrade rate.

* 3 or more foci on core biopsy and micropapillary architecture predict greater risk.

Diagnostic reproducibility

Multiple studies have indicated that interobserver agreement is poor, particularly when standardized criteria are not used.

Most variability among ADH vs small volume LG DCIS

In one study, diagnostic consistency was not significantly better when interpretation was confined to a single image, rather than the whole slide(s), reflecting inconsistencies in morphological interpretation

?Concerns re accurate risk of breast ca development because of this

Elston et al. Eur J Cancer 2000; 36: 1769-72.

Diagnostic reproducibility

Jain et al. Mod Pathol 2011 Jul;24(7):917-23.