Introduction
Materials and methods
Selection of patients
Surgical biopsies and tissue sampling: serial macroscopic sectioning
Classification of lesions and review of slides
Atypical ductal hyperplasia: definition and sizing
Follow-up of patients with epithelial atypia as a single lesion
Statistical analyses
Results
Occurrence of epithelial atypia in the 2,833 surgical biopsies
Types of epithelial atypia
Types of cancers associated with epithelial atypia
Epithelial atypia | FEA (n = 101) | ADH (n = 342) | LN (n = 223) | ADH + LN (n = 305) | ||||
---|---|---|---|---|---|---|---|---|
No. of cases (%) | No. of cases (%) | No. of cases (%) | No. of cases (%) | |||||
Without cancer | 84 | 83 | 220 | 64 | 139 | 62 | 227 | 74 |
With cancer | 17 | 17 | 122 | 36 | 84 | 38 | 78 | 26 |
DCIS/DCIS-MI | 12 | 12 | 103 | 30 | 58 | 26 | 60 | 20 |
IDC/NOS | – | – | 16 | 4.7 | 17 | 8 | 11 | 3 |
ILC | 1 | 1 | 1 | 0.3 | 6 | 3 | 5 | 2 |
TC | 4 | 4 | 2 | 1 | 3 | 1 | 2 | 1 |
Cancers without epithelial atypia (malignancy alone)
Subsequent cancer in patients with an initial diagnosis of epithelial atypia as a single lesion
Discussion
Application of the WHO classification: practical considerations
Spectrum of lesions | 1, 3–5 Layers | No polarization* | With polarization | |
---|---|---|---|---|
Occasional mounding | Mounding, arcades | Cribriform spaces and their variants | ||
No or rare arcades and micropapillary formations | Cohesive micropapillary tufts with a broad base | Non-cohesive micropapillary tufts with a tight base | ||
[70] | Flat epithelial atypia/DIN 1A | ADH/DIN 1B ≤ 2 mm; or in two spaces | DCIS/DIN 1C | |
[59] | Columnar cell hyperplasia with atypia | ADH if not extensive | DCIS if extensive | |
[61] | Columnar cell change (CCC) with cytologic atypia | Complex structures with architectural and cytologic atypia | ||
[34] | Columnar cell lesions + ADH | Microscopic focus of DCIS | DCIS | |
Institut Bergonié | Ex-clinging carcinoma of monomorphic type | ADH “mimicking” DCIS | ADH corresponding to “mini” DCIS ≤ 2 mm | DCIS |
[64] | CCC with cytologic atypia | CCH with architectural atypia | CCH with architectural atypia | DCIS |
Or | And | |||
CCH with cytologic atypia | Cytologic atypia | |||
Regrouping? | DIN 1A | ADH/DIN 1B | ADH/DIN 1C | DCIS/DIN 1C |
Not measured | Measured: ≤3 mm | >3 mm |