J Breast Cancer.  2012 Dec;15(4):407-411. 10.4048/jbc.2012.15.4.407.

Validation of a Scoring System for Predicting Malignancy in Patients Diagnosed with Atypical Ductal Hyperplasia Using an Ultrasound-Guided Core Needle Biopsy

• Kim J
• Han W
• Go EY
• Moon HG
• Ahn SK
• Shin HC
• You JM
• Chang JM
• Cho N
• Moon WK
• Park IA
• Noh DY

• KMID: 2286437
• DOI: http://doi.org/10.4048/jbc.2012.15.4.407

Abstract

PURPOSE
The need for surgical excision in patients with ultrasound-guided core needle biopsy (CNB)-diagnosed atypical ductal hyperplasia (ADH) remains an issue of debate. The present study sought to validate a scoring system (the U score, for underestimation) that we have previously developed for predicting malignancy in CNB-diagnosed ADH.
METHODS
The study prospectively enrolled 85 female patients with CNB-diagnosed ADH who underwent subsequent surgical excision. Underestimation was defined as a surgical specimen having malignant foci.
RESULTS
The overall underestimation rate was 37% (31/85). Multivariate analysis showed that a clinically palpable mass, microcalcification on imaging, size >15 mm and a patient age of > or =50 years were independently associated with underestimation. When applied to the scoring system, the validation score was significant (p<0.001; area under the curve, 0.852). No patient with a U score <3.5 had an underestimated lesion.
CONCLUSION
The present study successfully validated the efficacy of our scoring system for predicting malignancy in CNB-diagnosed ADH. A U score of < or =3.5 indicates that surgical excision may not be necessary.

Keyword

Breast hyperplasia; Breast neoplasms; Diagnostic errors; Needle biopsy

MeSH Terms

Biopsy, Large-Core Needle
Biopsy, Needle
Breast Neoplasms
Diagnostic Errors
Female
Humans
Hyperplasia
Multivariate Analysis
Prospective Studies

Figure

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  Figure 1 The receiver operating characteristic curve for the U scoring system. U score=3.5×age (age ≤50=0, age >50=1)+2.0×palpability (non-palpable=0, palpable=1)+2.0×microcalcification (no=0, yes=1) +3.5×sonographic size (≤1.5 cm=0, >1.5 cm=1)+3.5×multiplicity (focal=0, multiple=1). Area under the curve=0.852 (p<0.001; 95% confidence interval, 0.729-0.907).

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