{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:16:39Z","timestamp":1791314199892,"version":"4.3.1"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T00:00:00Z","timestamp":1708560000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T00:00:00Z","timestamp":1708560000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Excision is routinely recommended for atypical ductal hyperplasia (ADH) found on core biopsy given cancer upstage rates of near 20%. Identifying a cohort at low-risk for upstage may avoid low-value surgery. Objectives were to elucidate factors predictive of upstage in ADH, specifically near-complete core sampling, to potentially define a group at low upstage risk.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Patients and Methods<\/jats:title>\n                <jats:p>This retrospective, cross-sectional, multi-institutional study from 2015 to 2019 of 221 ADH lesions in 216 patients who underwent excision or active observation (\u2265 12 months imaging surveillance, mean follow-up 32.6 months) evaluated clinical, radiologic, pathologic, and procedural factors for association with upstage. Radiologists prospectively examined imaging for lesional size and sampling proportion.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Upstage occurred in 37 (16.7%) lesions, 25 (67.6%) to ductal carcinoma in situ (DCIS) and 12 (32.4%) to invasive cancer. Factors independently predictive of upstage were lesion size \u2265 10 mm (OR 5.47, 95% CI 2.03\u201314.77, <jats:italic>p<\/jats:italic> &lt; 0.001), pathologic suspicion for DCIS (OR 12.29, 95% CI 3.24\u201346.56, <jats:italic>p<\/jats:italic> &lt; 0.001), and calcification distribution pattern (OR 8.08, 95% CI 2.04\u201332.00, <jats:italic>p<\/jats:italic> = 0.003, \u201cregional\u201d; OR 19.28, 95% CI\u00a03.47\u2013106.97, <jats:italic>p<\/jats:italic> &lt; 0.001, \u201clinear\u201d). Near-complete sampling was not correlated with upstage (<jats:italic>p<\/jats:italic> = 0.64). All three significant predictors were absent in 65 (29.4%) cases, with a 1.5% upstage rate.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The upstage rate among 221 ADH lesions was 16.7%, highest in lesions \u2265 10\u00a0mm, with pathologic suspicion of DCIS, and linear\/regional calcifications on mammography. Conversely, 30% of the cohort exhibited all low-risk factors, with an upstage rate &lt; 2%, suggesting that active surveillance may be permissible in lieu of surgery.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1245\/s10434-024-15041-1","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T16:02:38Z","timestamp":1708617758000},"page":"3177-3185","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Determination of Factors Associated with Upstage in Atypical Ductal Hyperplasia to Identify Low-Risk Patients Where Active Surveillance May be an Alternative"],"prefix":"10.1245","volume":"31","author":[{"given":"Alexandra J. 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