Atypical Ductal Hyperplasia Diagnosed at Sonographically Guided 14-Gauge Core Needle Biopsy of Breast Mass

OBJECTIVE. The purpose of this study was to evaluate the surgical outcome of atypical ductal hyperplasia (ADH) diagnosed at sonographically guided 14-gauge core needle biopsy of breast masses and to determine whether the clinical, procedural, and radiologic features of this lesion can be used to predict upgrade to malignancy. MATERIALS AND METHODS. We retrospectively reviewed the pathologic results of sonographically guided 14-gauge core needle biopsy of solid breast masses. A total of 21 ADH lesions diagnosed with this procedure and surgically excised were included in the study. For each lesion, medical records and images were reviewed, and clinical, procedural, and radiologic variables were coded. The mammographic and sonographic features were determined, and the BI-RADS assessment category was noted. We compared underestimation rates among the collected variables. RESULTS. The results of surgical excision of 21 ADH lesions were malignancy in 13 cases (62% rate of underestimation of ADH). In comparison of rates of underestimation of malignancy among clinical and procedural variables, no statistically significant differences were found. There also was no significant difference among lesion characteristics and BI-RADS categories at mammography and sonography. CONCLUSION. ADH diagnosed at sonographically guided 14-gauge core needle biopsy has a high underestimation rate with respect to the results of surgical excision. Surgical excision should be recommended when ADH is diagnosed at sonographically guided 14-gauge core needle biopsy of breast masses.