Evidence map›Paper›PMID 41432796›Full record

ArticleAnnals of surgical oncology2026

External Validation of a Pragmatic Scoring System for Predicting Upgrade of Atypical Ductal Hyperplasia at the Time of Surgery.

Walter R F Donica, Dimond S Shartzer, Varun G Ramakrishnan, Elsa Kuhl, Daniel D Mais, Kelly M McMasters, Nicolas Ajkay

Abstract readMulticenter StudyValidation Study
PubMed Publisher
In one paragraph

Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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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

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3 · Its place in the literature

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0 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Walter R F DonicaThe Hiram C. Polk, Jr., Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA.
Dimond S ShartzerThe University of Louisville School of Medicine, Louisville, KY, USA.
Varun G RamakrishnanDepartment of Radiology, University of Louisville, Louisville, KY, USA.
Elsa KuhlDepartment of Radiology, University of Louisville, Louisville, KY, USA.
Daniel D MaisDepartment of Pathology, University of Louisville, Louisville, KY, USA.
Kelly M McMastersThe Hiram C. Polk, Jr., Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA.
Nicolas AjkayThe Hiram C. Polk, Jr., Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA. nicolas.ajkay@louisville.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAtypical ductal hyperplasia (ADH) carries a variable risk of upgrade at the time of surgery to ductal carcinoma in situ (DCIS) or invasive malignancy. We sought to externally validate a pragmatic upgrade risk scoring system previously demonstrated to have an upgrade rate of 0-2% in patients with a risk score of 0 out of 5.

methodsA multicenter, retrospective review of all percutaneous biopsies containing ADH was performed from 2017 to 2023. Women aged ≥ 18 years who underwent diagnostic mammography and surgical excision for pathologic correlation were included.

resultsAmong the 183 cases included, the mean age was 58 years ± standard deviation 11, and 91 patients (50%) reported a family history of breast cancer. Most biopsies were stereotactic (75%), vacuum-assisted (84%), and used 9-gauge needles (73%). Three of 14 (21%) patients with a risk score of 0 were upgraded to DCIS following surgical excision. Seven (19%) patients had a risk score of 1 upgraded - six to DCIS and one to an estrogen receptor-positive/progesterone receptor-positive/human epidermal growth factor receptor 2-negative invasive ductal carcinoma measuring 5.45 mm in largest diameter. On multivariate analysis, age, mammographic lesion size, and suspicion of DCIS on biopsy were predictive of upgrade.

conclusionsThe risk model evaluated generally predicts the risk of upgrade of ADH at excisional biopsy but may underestimate the upgrade rate in the lowest-risk cohort. Because of the small sample size, further work is needed to determine whether the rate of upgrade is truly low enough in this lowest-risk cohort to recommend against excisional biopsy.

Indexed as

Breast NeoplasmsCarcinoma, Ductal, BreastCarcinoma, Intraductal, NoninfiltratingAdultAgedFemaleFollow-Up StudiesHumansHyperplasiaMammographyMiddle AgedPrognosisRetrospective StudiesRisk AssessmentAtypical ductal hyperplasiaPredictingScoring systemUpgrade

Identifiers

PMID41432796

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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.