Atypical ductal hyperplasia (ADH) diagnosed on core biopsy is associated with an upgrade risk to ductal carcinoma in situ (DCIS) or invasive carcinoma on surgical excision. This cross-sectional study at the University of Miami analyzed imaging, clinical, and pathologic data from patients diagnosed with ADH on core biopsy between January 2020 and June 2023, with the aim of identifying features least associated with upgrade — and therefore patients who may potentially be spared surgery.

Seventy-one core biopsies from 70 patients were included after excluding three histologic-radiologic discordant cases. All imaging and histologic slides were re-reviewed by breast radiologists and pathologists.

As described in the study's methods, surgical excision specimens were entirely submitted or submitted in up to 20 cassettes, with larger excisions and mastectomies ensuring the entire imaging target and adjacent tissue were examined histologically. Specimens were radiographed using a Kubtec imaging system to identify all biopsy markers before tissue sampling.

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