Definition
- Intraductal clonal epithelial cell proliferation with similar histologic features to (but insufficient involvement or volume for the diagnosis of) low grade Ductal Carcinoma in Situ (DCIS)
Features
- Intraductal clonal epithelial cell proliferation with cytologic and morphologic features similar to low grade ductal carcinoma in situ
- Differentiated from low grade ductal carcinoma in situ by size (≤ 2 mm) or space occupied by clonal cells (≤ 2 spaces or only portion of involved space)
- Rigid bridges, polarization around lumen and estrogen receptor (ER) (diffuse, strong) positivity
- Differentiated from Florid ductal hyperplasia by atypia
Management
- Excise to clear margins
- If ADH is diagnosed on an excisional biopsy, no additional surgery is indicated. Re-excision is generally not indicated when ADH is present at the margin.
- The only exception may be if the ADH is only present at the margin, is bordering on reaching criteria for diagnosis as DCIS at the margin, or there is concern that the imaging target was not completely excised; in these situations, a re-excision merits consideration.
Natural hx
- Association with DCIS and IDC
- Upgrade to malignancy seen in 30% of excisions
- RR for breast Ca 3.7
- Likelihood of synchronous malignancy 33-87%
Follow up
- Mammograms annually for 5 yrs
Other
RR of Cancer:
