{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T18:43:58Z","timestamp":1763664238416,"version":"3.41.2"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"1110","license":[{"start":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T00:00:00Z","timestamp":1585699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,1]]},"abstract":"<jats:p>Among lesions with uncertain malignant potential found at percutaneous breast biopsy, atypical ductal hyperplasia (ADH) carries both the highest risk of underestimation and the closest and most pathologist-dependent differential diagnosis with ductal carcinoma in situ (DCIS), matching the latter\u2019s features save for size only. ADH is therefore routinely surgically excised, but single-centre studies with limited sample size found low rates of upgrade to invasive cancer or DCIS. This suggests the possibility of surveillance over surgery in selected subgroups, considering the 2% threshold allowing for follow-up according to the Breast Imaging Reporting and Data System. A recent meta-analysis on 6458 lesions counters this approach, confirming that, surgically excised or managed with surveillance, ADH carries a 29% and 5% upgrade rate, respectively, invariably higher than 2% even in subgroups considering biopsy guidance and technique, needle calibre, apparent complete lesion removal. The high heterogeneity (I \u00a02 = 80%) found in this meta-analysis reaffirmed the need to synthesise evidence from systematic reviews to achieve generalisable results, fit for guidelines development. Limited tissue sampling at percutaneous biopsy intrinsically hampers the prediction of ADH-associated malignancy. This prediction could be improved by using contrast-enhanced breast imaging and applying artificial intelligence on both pathology and imaging results, allowing for overtreatment reduction.<\/jats:p>","DOI":"10.1259\/bjr.20200117","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T19:32:05Z","timestamp":1585078325000},"source":"Crossref","is-referenced-by-count":8,"title":["An update on the management of breast atypical ductal hyperplasia"],"prefix":"10.1093","volume":"93","author":[{"given":"Simone","family":"Schiaffino","sequence":"first","affiliation":[{"name":"Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30 , 20097 San Donato Milanese , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4922-7065","authenticated-orcid":false,"given":"Andrea","family":"Cozzi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, Via Mangiagalli 31 , 20133 Milano , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Sardanelli","sequence":"additional","affiliation":[{"name":"Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30 , 20097 San Donato Milanese , Italy"},{"name":"Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, Via Mangiagalli 31 , 20133 Milano , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,4,1]]},"reference":[{"key":"2024050215250999800_b1","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1038\/bjc.2013.253","article-title":"Trends in breast biopsies for abnormalities detected at screening mammography: a population-based study in the Netherlands","volume":"109","author":"van Breest Smallenburg","year":"2013","journal-title":"Br J Cancer"},{"key":"2024050215250999800_b2","doi-asserted-by":"crossref","DOI":"10.1259\/bjr.20160595","article-title":"The B3 conundrum-the radiologists' perspective","volume":"90","author":"Sharma","year":"2017","journal-title":"Br J Radiol"},{"key":"2024050215250999800_b3","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.ejso.2018.12.008","article-title":"High risk (B3) breast lesions: what is the incidence of malignancy for individual lesion subtypes? 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