Let’s move on to a discussion of atypical ductal hyperplasia. Remember, ADH or atypical
ductal hyperplasia is considered a proliferative disease and may infer increased risk of cancer,
proliferation of cells and histologically very similar to in-situ cancer. However, atypical ductal
hyperplasia in and of itself is not considered premalignant. There is however, an increased
risk of breast cancer three to five fold in the general average population. And it’s usually
discovered incidentally on biopsy of either a palpable mass or a mammographic abnormality.
Remember, these are incidental findings. Here’s a mammogram of an atypical ductal hyperplasia.
It is difficult to distinguish based on the mammogram alone. Again, as a reminder, typically
when mammogram showed microcalcifications or suspicious lesions, patients undergo some
type of biopsy. When the biopsy result shows atypical ductal hyperplasia, it does not necessarily
explain the microcalcifications. For biopsies, if it’s a palpable lesion, one can again do a core
needle biopsy. If it’s not palpable, one can send the patient for a stereotactic biopsy where
3D reconstructions guide an automated machine to biopsy the lesion. This stereotactic biopsy
minimizes the need for an excisional biopsy or incisional biopsy in the operating room.
The question is, is surgery needed for atypical ductal hyperplasia? The answer is no. If a biopsy
result shows atypical ductal hyperplasia, no excision is needed as the lesion itself is not premalignant
or malignant. However, remember it confers increased risk of invasive cancer and that should
be told to the patient in counseling. The patient may also be responsive to hormonal therapy.
Here in risk reduction, estrogen receptor modulators such as tamoxifen may be given to
patients with atypical ductal hyperplasia to decrease the risk of invasive cancer. Here are
some important clinical pearls and high-yield information. Do not assume that all mammographic
abnormalities are malignant. Similarly, if a mammographic abnormality is demonstrated
and the biopsy result shows a benign lesion, perhaps more biopsies are needed. Excision is
not necessary in atypical ductal hyperplasia. But because this is a proliferative form of benign
breast disease, it infers increased risk to the patient. Estrogen receptor modulators may be
used to decrease risk of invasive cancer. Thank you very much for joining me on this discussion
of benign breast disease.