Atypical ductal hyperplasia diagnosed by US-guided core needle biopsy: clinical, pathological and US features associated with upgrading to malignancy
Abstract Background To develop a predictive model to identify atypical ductal hyperplasia (ADH) that was underestimated by US-guided core needle biopsy (CNB) and to evaluate the risk factors for underestimation for ADH with intraductal papilloma diagnosed by CNB. Methods In this retrospective study,...
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BMC
2025-05-01
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| Series: | BMC Medical Imaging |
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| Online Access: | https://doi.org/10.1186/s12880-025-01707-z |
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| author | Jun Kang Li Yong Jie Xu Rui Lan Niu Nai Qin Fu Zhi Ying Jin Shi Yu Li Yu Chen Liu Zhi Li Wang |
| author_facet | Jun Kang Li Yong Jie Xu Rui Lan Niu Nai Qin Fu Zhi Ying Jin Shi Yu Li Yu Chen Liu Zhi Li Wang |
| author_sort | Jun Kang Li |
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| description | Abstract Background To develop a predictive model to identify atypical ductal hyperplasia (ADH) that was underestimated by US-guided core needle biopsy (CNB) and to evaluate the risk factors for underestimation for ADH with intraductal papilloma diagnosed by CNB. Methods In this retrospective study, 300 CNB-diagnosed ADH lesions in 291 consecutive women between January 2014 and July 2023 were included and divided into training set (n = 181), internal validation set (n = 54), and external validation set (n = 65). The review included clinical, pathological, and US features, as well as final outcomes. Multivariate logistic regression was employed to establish predictive model and to evaluate risk factors. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration curve, decision curve analysis, and utility (patient stratification into low and high-risk groups). Model was validated both internally and externally by calculating its performance on validation sets. Results The upgrade rate to malignancy was 51.0%. Predictors included in the model were age, the pathological pattern of ADH with intraductal papilloma or ADH alone, Ki-67 positivity, and imaging-pathological discordance. The AUC was 0.915 (95% CI: 0.858, 0.955) in the training set, 0.906 (95% CI: 0.785, 0.972) in the internal validation set, and 0.934 (95% CI: 0.836, 0.983) in the external validation set. Using a cutoff value of 0.11, 38.3% of nonmalignant lesions in the training set were stratified into low-risk group with an upgrade rate of 4.1%. Similar results were obtained in the validation sets. For ADH with intraductal papilloma, age and imaging-pathological discordance were the independent risk factors for malignancy upgrading. Conclusions The model established to predict ADH upgrading can help in individualized risk management. If predictors of non-upgraded ADH lesions can be confirmed with larger studies, more than one-third of non-malignant lesions are expected to be candidates for non-excision. Trial registration This is a retrospective study. |
| format | Article |
| id | doaj-art-3f951099acae433ba44ea5d7eefaf73b |
| institution | OA Journals |
| issn | 1471-2342 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | BMC Medical Imaging |
| spelling | doaj-art-3f951099acae433ba44ea5d7eefaf73b2025-08-20T02:34:19ZengBMCBMC Medical Imaging1471-23422025-05-0125111310.1186/s12880-025-01707-zAtypical ductal hyperplasia diagnosed by US-guided core needle biopsy: clinical, pathological and US features associated with upgrading to malignancyJun Kang Li0Yong Jie Xu1Rui Lan Niu2Nai Qin Fu3Zhi Ying Jin4Shi Yu Li5Yu Chen Liu6Zhi Li Wang7Department of Ultrasound, The First Medical Center, Chinese PLA General HospitalDepartment of Ultrasound Diagnosis, The Ninth Medical Center, Chinese PLA General HospitalDepartment of Ultrasound, The First Medical Center, Chinese PLA General HospitalDepartment of Ultrasound, The First Medical Center, Chinese PLA General HospitalDepartment of Ultrasound, The First Medical Center, Chinese PLA General HospitalDepartment of Ultrasound, The First Medical Center, Chinese PLA General HospitalDepartment of Gastroenterology, Chinese PLA 63820 HospitalDepartment of Ultrasound, The First Medical Center, Chinese PLA General HospitalAbstract Background To develop a predictive model to identify atypical ductal hyperplasia (ADH) that was underestimated by US-guided core needle biopsy (CNB) and to evaluate the risk factors for underestimation for ADH with intraductal papilloma diagnosed by CNB. Methods In this retrospective study, 300 CNB-diagnosed ADH lesions in 291 consecutive women between January 2014 and July 2023 were included and divided into training set (n = 181), internal validation set (n = 54), and external validation set (n = 65). The review included clinical, pathological, and US features, as well as final outcomes. Multivariate logistic regression was employed to establish predictive model and to evaluate risk factors. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration curve, decision curve analysis, and utility (patient stratification into low and high-risk groups). Model was validated both internally and externally by calculating its performance on validation sets. Results The upgrade rate to malignancy was 51.0%. Predictors included in the model were age, the pathological pattern of ADH with intraductal papilloma or ADH alone, Ki-67 positivity, and imaging-pathological discordance. The AUC was 0.915 (95% CI: 0.858, 0.955) in the training set, 0.906 (95% CI: 0.785, 0.972) in the internal validation set, and 0.934 (95% CI: 0.836, 0.983) in the external validation set. Using a cutoff value of 0.11, 38.3% of nonmalignant lesions in the training set were stratified into low-risk group with an upgrade rate of 4.1%. Similar results were obtained in the validation sets. For ADH with intraductal papilloma, age and imaging-pathological discordance were the independent risk factors for malignancy upgrading. Conclusions The model established to predict ADH upgrading can help in individualized risk management. If predictors of non-upgraded ADH lesions can be confirmed with larger studies, more than one-third of non-malignant lesions are expected to be candidates for non-excision. Trial registration This is a retrospective study.https://doi.org/10.1186/s12880-025-01707-zAtypical ductal hyperplasiaUltrasoundBreast neoplasmsBiopsy |
| spellingShingle | Jun Kang Li Yong Jie Xu Rui Lan Niu Nai Qin Fu Zhi Ying Jin Shi Yu Li Yu Chen Liu Zhi Li Wang Atypical ductal hyperplasia diagnosed by US-guided core needle biopsy: clinical, pathological and US features associated with upgrading to malignancy BMC Medical Imaging Atypical ductal hyperplasia Ultrasound Breast neoplasms Biopsy |
| title | Atypical ductal hyperplasia diagnosed by US-guided core needle biopsy: clinical, pathological and US features associated with upgrading to malignancy |
| title_full | Atypical ductal hyperplasia diagnosed by US-guided core needle biopsy: clinical, pathological and US features associated with upgrading to malignancy |
| title_fullStr | Atypical ductal hyperplasia diagnosed by US-guided core needle biopsy: clinical, pathological and US features associated with upgrading to malignancy |
| title_full_unstemmed | Atypical ductal hyperplasia diagnosed by US-guided core needle biopsy: clinical, pathological and US features associated with upgrading to malignancy |
| title_short | Atypical ductal hyperplasia diagnosed by US-guided core needle biopsy: clinical, pathological and US features associated with upgrading to malignancy |
| title_sort | atypical ductal hyperplasia diagnosed by us guided core needle biopsy clinical pathological and us features associated with upgrading to malignancy |
| topic | Atypical ductal hyperplasia Ultrasound Breast neoplasms Biopsy |
| url | https://doi.org/10.1186/s12880-025-01707-z |
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