Evidence map›Paper›PMID 42371317›Full record

ArticleAnnals of surgical oncology2026

Risk Stratification of Atypical Breast Lesions Diagnosed on Core Needle Biopsy: Toward Selective Surgical Excision.

Victoria Chamberlain, Logan R Holt, Tyler P Shern, Michele A Gadd, Michelle C Specht, Manisha Bahl, Barbara L Smith, Tolga Ozmen

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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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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Victoria ChamberlainDivision of Breast Surgery, Harvard Medical School, Mass General Brigham, Boston, MA, USA.
Logan R Holt *Division of Breast Surgery, Harvard Medical School, Mass General Brigham, Boston, MA, USA.
Tyler P Shern *Division of Breast Surgery, Harvard Medical School, Mass General Brigham, Boston, MA, USA.
Michele A GaddDivision of Breast Surgery, Harvard Medical School, Mass General Brigham, Boston, MA, USA.
Michelle C SpechtDivision of Breast Surgery, Harvard Medical School, Mass General Brigham, Boston, MA, USA.
Manisha BahlDivision of Breast Imaging, Mass General Brigham, Boston, MA, USA.
Barbara L SmithDivision of Breast Surgery, Harvard Medical School, Mass General Brigham, Boston, MA, USA.
Tolga OzmenDivision of Breast Surgery, Harvard Medical School, Mass General Brigham, Boston, MA, USA. tozmen@mgh.harvard.edu.ORCID http://orcid.org/0000-0002-7136-6195

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAtypical ductal hyperplasia (ADH) and lobular intraepithelial neoplasia (LIN) identified on core needle biopsy have variable rates of upgrade to malignancy when surgically excised. Although excision is recommended for ADH, management of LIN has shifted toward a selective approach. We evaluated upgrade rates and developed a risk stratification model to guide management.

methodsWe conducted a retrospective study of 502 women diagnosed with ADH and/or LIN on core needle biopsy from 2020 to 2023 at an academic institution. Included patients underwent surgical excision or had at least 2-year follow-up. Upgrade rates to ductal carcinoma in situ (DCIS) or invasive carcinoma were assessed. Multivariable logistic regression identified predictors of upgrade.

resultsOverall upgrade rates were 14.0% for ADH, 2.4% for LIN, and 18.0% for concurrent ADH+LIN (p<0.001). Among excised lesions, upgrades in ADH were predominantly DCIS (79.5%), whereas all upgrades in LIN were invasive carcinomas. All invasive cancers were low stage (stage IA). On multivariable analysis, age >70 years, prior contralateral breast cancer, dense tissue on mammography, and severe atypia were independent predictors of upgrade. Patients were stratified into low- (0 factors), moderate- (1 factor), and high-risk (≥2 factors) groups; upgrade rates were 4.2, 16.5 and 25.5%, respectively. Among patients managed nonoperatively, one ADH case was subsequently diagnosed as DCIS.

conclusionsUpgrade risk in atypical breast lesions varies by lesion type and clinical factors. A risk-based approach identifies a subset of patients-particularly those with LIN or low-risk ADH-who may be managed without excision, potentially reducing unnecessary surgery while maintaining oncologic safety.

Indexed as

Breast Carcinoma In SituBreast NeoplasmsCarcinoma, Ductal, BreastCarcinoma, Intraductal, NoninfiltratingCarcinoma, LobularAdultAgedBiopsy, Large-Core NeedleFemaleFollow-Up StudiesHumansMiddle AgedPrognosisRetrospective StudiesRisk AssessmentAtypical breast lesionBreast mammographyCore needle biopsyRisk stratificationSurgical decision-making

Identifiers

PMID42371317

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