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

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

Abstract

Background
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.

Conclusions
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.

Citation

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. https://doi.org/10.1186/s13058-018-0967-1

• 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
• DOI: https://doi.org/10.1186/s13058-018-0967-1
• Keywords: Atypical ductal hyperplasia; Breast neoplasms; Ductal carcinoma in situ; Breast cancer progression; Clonal relationship; Patient care management
• Public URL: https://nottingham-repository.worktribe.com/output/1188787
• Publisher URL: https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-018-0967-1