Atypical ductal hyperplasia (ADH) is the term used for a

benign Malignancy () is the tendency of a medical condition to become progressively worse. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malign ...

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classifi ...

of the breast that indicates an increased risk of

breast cancer Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a re ...

. The name of the entity is descriptive of the lesion; ADH is characterized by cellular proliferation (

hyperplasia Hyperplasia (from ancient Greek ὑπέρ ''huper'' 'over' + πλάσις ''plasis'' 'formation'), or hypergenesis, is an enlargement of an organ or tissue caused by an increase in the amount of organic tissue that results from cell proliferati ...

) within one or two breast ducts and ( histomorphologic) architectural abnormalities, i.e. the cells are arranged in an abnormal or atypical way. In the context of a core (needle) biopsy, ADH is considered an indication for a breast lumpectomy, also known as a surgical (excisional) biopsy, to exclude the presence of

Signs and symptoms

ADH, generally, is asymptomatic. It usually comes to

medical attention First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial int ...

on a

screening mammogram Breast cancer screening is the medical screening of asymptomatic, apparently healthy women for breast cancer in an attempt to achieve an earlier diagnosis. The assumption is that early detection will improve outcomes. A number of screening tests ...

, as a non-specific suspicious abnormality that requires a

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...

Pathology

ADH,

cytologically Cell biology (also cellular biology or cytology) is a branch of biology that studies the structure, function, and behavior of cells. All living organisms are made of cells. A cell is the basic unit of life that is responsible for the living and ...

architecturally Architecture is the art and technique of designing and building, as distinguished from the skills associated with construction. It is both the process and the product of sketching, conceiving, planning, designing, and constructing buildings ...

and on a

molecular A molecule is a group of two or more atoms held together by attractive forces known as chemical bonds; depending on context, the term may or may not include ions which satisfy this criterion. In quantum physics, organic chemistry, and bioche ...

basis, is identical to a low-grade

ductal carcinoma in situ Ductal carcinoma in situ (DCIS), also known as intraductal carcinoma, is a pre-cancerous or non-invasive cancerous lesion of the breast. DCIS is classified as Stage 0. It rarely produces symptoms or a breast lump one can feel, typically being d ...

(DCIS); however, it has a limited extent, i.e. is present in a very small amount (< 2 mm). Image:Atypical ductal hyperplasia - low mag.jpg , Low mag. Image:Atypical ductal hyperplasia - high mag.jpg , High mag.

Relation to low-grade ductal carcinoma in situ

While the histopathologic features and molecular features of ADH are that of (low-grade) DCIS, its clinical behaviour, unlike low-grade DCIS, is substantially better; thus, the more aggressive treatment for DCIS is not justified.

Diagnosis

Atypical ductal hyperplasia with immunotyping

It is diagnosed based on tissue, e.g. a

, showing ductal hyperplasia. There is no single definite cutoff that separates atypical ductal hyperplasia from

, but the following are important distinctive features of atypical ductal hyperplasia, with suggested cutoffs: *Size less than 2 mm. *Not involving more than one duct. *The atypical epithelial proliferation is admixed with a second population of proliferative cells without atypia. *The proliferation completely involves the terminal ductal lobular unit(s), to a limited extent.

Treatment

ADH, if found on a surgical (excisional) biopsy of a mammographic abnormality, does not require any further treatment, only mammographic follow-up. If ADH is found on a core (needle) biopsy (a procedure which generally does not excise a suspicious mammographic abnormality), a surgical biopsy, i.e. a breast lumpectomy, to completely excise the abnormality and exclude breast cancer is the typical recommendation.

Prognosis

Cancer risk for ADH on a core biopsy

The rate at which breast cancer (

''or'' invasive mammary carcinoma (all breast cancer except DCIS and LCIS)) is found at the time of a surgical (excisional) biopsy, following the diagnosis of ADH on a core (needle) biopsy varies considerably from hospital-to-hospital (range 4-54%). In two large studies, the conversion of an ADH on core biopsy to breast cancer on surgical excision, known as "up-grading", is approximately 30%.

Cancer risk based on follow-up

The

relative risk The relative risk (RR) or risk ratio is the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group. Together with risk difference and odds ratio, relative risk measures the association bet ...

based on a

median follow-up In statistics, median follow-up is the median time between a specified event and the time when data on outcomes are gathered. The concept is used in cancer survival analyses. Many cancer studies aim to assess the time between two events of inter ...

of 8 years, in a

case control study Case or CASE may refer to: Containers * Case (goods), a package of related merchandise * Cartridge case or casing, a firearm cartridge component * Bookcase, a piece of furniture used to store books * Briefcase or attaché case, a narrow box to c ...

of US

registered nurse A registered nurse (RN) is a nurse who has graduated or successfully passed a nursing program from a recognized nursing school and met the requirements outlined by a country, state, province or similar government-authorized licensing body to o ...

s, is 3.7.

References

External links

What is atypical ductal hyperplasia? (hopkinsmedicine.org)
{{Breast neoplasia Benign neoplasms Breast neoplasia