Evidence map›Paper›PMID 38386195›Full record

ArticleAnnals of surgical oncology2024

Determination of Factors Associated with Upstage in Atypical Ductal Hyperplasia to Identify Low-Risk Patients Where Active Surveillance May be an Alternative.

Alexandra J E Greene, Joshua Davis, Jessica Moon, Iram Dubin, Anastasia Cruz, Megha Gupta, Ashkan Moazzez, Junko Ozao-Choy, Esha Gupta, Tejas Manchandia and 3 more

Open access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of surgical oncology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.3field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 3 citations in OpenAlex.

  1. Article
  2. Review
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  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 5 institutions in 1 country.

Alexandra J E GreeneDepartment of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
Joshua DavisDepartment of Radiology, Harbor-UCLA Medical Center, Torrance, CA, USA.
Jessica MoonDepartment of Radiology, Harbor-UCLA Medical Center, Torrance, CA, USA.
Iram DubinDepartment of Radiology, Olive View Medical Center, Sylmar, CA, USA.
Anastasia CruzDepartment of Radiology, USC+LAC Medical Center, Los Angeles, CA, USA.
Megha GuptaDepartment of Radiology, USC+LAC Medical Center, Los Angeles, CA, USA.
Ashkan MoazzezDepartment of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
Junko Ozao-ChoyDepartment of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
Esha GuptaDepartment of Radiology, High Desert Regional Health Center, Lancaster, CA, USA.
Tejas ManchandiaDepartment of Radiology, UCLA Medical Center, Los Angeles, CA, USA.
Babak N KalantariDepartment of Radiology, Harbor-UCLA Medical Center, Torrance, CA, USA.
Guita RahbarDepartment of Radiology, Olive View Medical Center, Sylmar, CA, USA.
Christine DauphineDepartment of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA. cdauphine@dhs.lacounty.gov.ORCID http://orcid.org/0000-0002-1766-6680
UCLA Medical Center · USLAC+USC Medical Center · USNewYork–Presbyterian Hospital · USOlive View-UCLA Medical Center · USRegional Health · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundExcision is routinely recommended for atypical ductal hyperplasia (ADH) found on core biopsy given cancer upstage rates of near 20%. Identifying a cohort at low-risk for upstage may avoid low-value surgery. Objectives were to elucidate factors predictive of upstage in ADH, specifically near-complete core sampling, to potentially define a group at low upstage risk. PATIENTS AND

methodsThis retrospective, cross-sectional, multi-institutional study from 2015 to 2019 of 221 ADH lesions in 216 patients who underwent excision or active observation (≥ 12 months imaging surveillance, mean follow-up 32.6 months) evaluated clinical, radiologic, pathologic, and procedural factors for association with upstage. Radiologists prospectively examined imaging for lesional size and sampling proportion.

resultsUpstage occurred in 37 (16.7%) lesions, 25 (67.6%) to ductal carcinoma in situ (DCIS) and 12 (32.4%) to invasive cancer. Factors independently predictive of upstage were lesion size ≥ 10 mm (OR 5.47, 95% CI 2.03-14.77, p < 0.001), pathologic suspicion for DCIS (OR 12.29, 95% CI 3.24-46.56, p < 0.001), and calcification distribution pattern (OR 8.08, 95% CI 2.04-32.00, p = 0.003, "regional"; OR 19.28, 95% CI 3.47-106.97, p < 0.001, "linear"). Near-complete sampling was not correlated with upstage (p = 0.64). All three significant predictors were absent in 65 (29.4%) cases, with a 1.5% upstage rate.

conclusionsThe upstage rate among 221 ADH lesions was 16.7%, highest in lesions ≥ 10 mm, with pathologic suspicion of DCIS, and linear/regional calcifications on mammography. Conversely, 30% of the cohort exhibited all low-risk factors, with an upstage rate < 2%, suggesting that active surveillance may be permissible in lieu of surgery.

Indexed as

Breast NeoplasmsCalcinosisCarcinoma, Ductal, BreastCarcinoma, Intraductal, NoninfiltratingBiopsy, Large-Core NeedleBreastCross-Sectional StudiesFemaleHumansHyperplasiaMammographyRetrospective StudiesWatchful WaitingAtypical ductal hyperplasia (ADH)Low-risk cohortPredictors of upstage

Identifiers

PMID38386195
PMCPMC10997526
OpenAlexW4392037142

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.