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Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape

Kader, Tanjina; Hill, Prue; Rakha, Emad A.; Campbell, Ian G.; Gorringe, Kylie L.

Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape Thumbnail


Tanjina Kader

Prue Hill

Professor of Breast Cancer Pathology

Ian G. Campbell

Kylie L. Gorringe


Atypical ductal hyperplasia (ADH) is a common diagnosis in the mammographic era and a significant clinical problem with wide variation in diagnosis and treatment. After a diagnosis of ADH on biopsy a proportion are upgraded to carcinoma upon excision; however, the remainder of patients are overtreated. While ADH is considered a non-obligate precursor of invasive carcinoma, the molecular taxonomy remains unknown.

Main text
Although a few studies have revealed some of the key genomic characteristics of ADH, a clear understanding of the molecular changes associated with breast cancer progression has been limited by inadequately powered studies and low resolution methodology. Complicating factors such as family history, and whether the ADH present in a biopsy is an isolated lesion or part of a greater neoplastic process beyond the limited biopsy material, make accurate interpretation of genomic features and their impact on progression to malignancy a challenging task. This article will review the definitions and variable management of the patients diagnosed with ADH as well as the current knowledge of the molecular landscape of ADH and its clonal relationship with ductal carcinoma in situ and invasive carcinoma.

Molecular data of ADH remain sparse. Large prospective cohorts of pure ADH with clinical follow-up need to be evaluated at DNA, RNA, and protein levels in order to develop biomarkers of progression to carcinoma to guide management decisions.


Kader, T., Hill, P., Rakha, E. A., Campbell, I. G., & Gorringe, K. L. (2018). Atypical ductal hyperplasia: update on diagnosis, management, and molecular landscape. Breast Cancer Research, 20, 1-11.

Journal Article Type Article
Acceptance Date Apr 2, 2018
Online Publication Date May 2, 2018
Publication Date 2018-12
Deposit Date Oct 25, 2018
Publicly Available Date Oct 25, 2018
Journal Breast Cancer Research
Print ISSN 1465-5411
Electronic ISSN 1465-542X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 20
Article Number 39
Pages 1-11
Keywords Atypical ductal hyperplasia; Breast neoplasms; Ductal carcinoma in situ; Breast cancer progression; Clonal relationship; Patient care management
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