Discrepancies in the diagnosis of intraductal proliferative lesions of the breast and its management implications: Results of a multinational survey

Department of Pathology, Yale University School of Medicine, Lauder Hall (LH) 222, 310 Cedar St., New Haven, CT 06510, USA.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin (Impact Factor: 2.65). 12/2006; 449(6):609-16. DOI: 10.1007/s00428-006-0245-y
Source: PubMed


To measure discrepancies in diagnoses and recommendations impacting management of proliferative lesions of the breast, a questionnaire of five problem scenarios was distributed among over 300 practicing pathologists. Of the 230 respondents, 56.5% considered a partial cribriform proliferation within a duct adjacent to unequivocal ductal carcinoma in situ (DCIS) as atypical ductal hyperplasia (ADH), 37.7% of whom recommended reexcision if it were at a resection margin. Of the 43.5% who diagnosed the partially involved duct as DCIS, 28.0% would not recommend reexcision if the lesion were at a margin. When only five ducts had a partial cribriform proliferation, 35.7% considered it as DCIS, while if >or=20 ducts were so involved, this figure rose to 60.4%. When one duct with a complete cribriform pattern measured 0.5, 1.5, or 4 mm, a diagnosis of DCIS was made by 22.6, 31.3, and 94.8%, respectively. When multiple ducts with flat epithelial atypia were at a margin, 20.9% recommended reexcision. Much of these discrepancies arise from the artificial separation of ADH and low-grade DCIS and emphasize the need for combining these two under the umbrella designation of ductal intraepithelial neoplasia grade 1 (DIN 1) to diminish the impact of different terminologies applied to biologically similar lesions.

Download full-text


Available from: Fattaneh A Tavassoli,
  • Source
    • "There is a large practice variation amongst American pathologists as well as demonstrated in the study conducted by Ghofrani et al. [18], which was described earlier in our paper. In addition to classifying the proliferative lesion adjacent to DCIS as ADH or DCIS, the pathologists were also asked what to do with the lesion if it involved the margin of a BCS specimen. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Negative margins are associated with a reduced risk of ipsilateral breast tumor recurrence (IBTR) in women with early stage breast cancer treated with breast conserving surgery (BCS). Not infrequently, atypical ductal hyperplasia (ADH) is reported as involving the margin of a BCS specimen, and there is no consensus among surgeons or pathologists on how to approach this diagnosis resulting in varied reexcision practices among breast surgeons. The purpose of this paper is to establish a reasonable approach to guide the treatment of ADH involving the margin after BCS for early stage breast cancer. Methods. the published literature was reviewed using the PubMed site from the US National Library of Medicine. Conclusions. ADH at the margin of a BCS specimen performed for early stage breast cancer is a controversial pathological diagnosis subject to large interobserver variability. There is not enough data evaluating this diagnosis to change current practice patterns; however, it is reasonable to consider reexcision for ADH involving a surgical margin, especially if it coexists with low grade DCIS. Further studies with longer followup and closer attention to ADH at the margin are needed to formulate treatment guidelines.
    International Journal of Surgical Oncology 12/2012; 2012:297832. DOI:10.1155/2012/297832
  • [Show abstract] [Hide abstract]
    ABSTRACT: Implantable cardioverter/defibrillator devices use different algorithms to recognize ventricular tachycardia and ventricular fibrillation from sinus rhythm. However problems remain, especially differentiating physiologic high rhythms from life threatening situations. In order to test detection abilities of different methods, off-line analysis was performed in time (rate counting, autocorrelation function, statistical methods) and in frequency (digital fast Fourier transform) domains on bipolar electrograms that were obtained in 28 patients during the implantation of an automatic defibrillator. Tachycardia and fibrillation were induced and recordings made of the ECG, right ventricular electrogram and aortic pressure. Results showed that even simple methods perform equally well compared to calculation intensive methods
    Computers in Cardiology 1994; 10/1994
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Columnar cell lesions of the breast represent a spectrum of lesions which have in common the presence of columnar epithelial cells lining variably dilated terminal duct lobular units, ranging from those that show little or no cytologic or architectural atypia to those that show sufficient cytologic and architectural features to warrant a diagnosis of atypical ductal hyperplasia or ductal carcinoma in situ. Recent studies have begun to provide insights into the biological nature and clinical significance of these lesions. In this article, we review the current state of knowledge and propose a simplified scheme for their classification.
    Advances in Anatomic Pathology 06/2003; 10(3):113-24. DOI:10.1097/00125480-200305000-00001 · 3.23 Impact Factor
Show more