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

Yale University, New Haven, Connecticut, United States
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.

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Available from: Fattaneh A Tavassoli
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    • "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. "
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