{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T08:10:30Z","timestamp":1778141430822,"version":"3.51.4"},"reference-count":27,"publisher":"Korean Society of Clinical Oncology","issue":"1","funder":[{"name":"Korean Society of Surgical Oncology","award":["KSSO-24-07"],"award-info":[{"award-number":["KSSO-24-07"]}]}],"content-domain":{"domain":["kjco.org"],"crossmark-restriction":true},"short-container-title":["Korean J Clin Oncol"],"abstract":"<jats:p>Purpose: Atypical hyperplasia (AH) management remains controversial due to variable malignant disease progression rates. While Western studies report 10% to 25% upgrade rates, data from Asian populations, particularly from referral academic centers, are limited. We aimed to identify predictive factors for malignant upgrade in Korean women with AH at academic hospitals.Methods: This retrospective multi-institutional study analyzed 340 patients diagnosed with AH on initial biopsy who underwent subsequent excision at five Korean academic hospitals from 2000 to 2022. Malignant upgrade was defined as ductal carcinoma in situ or invasive cancer on the final pathology. Multivariate logistic regression was used to identify independent predictors of upgrades.Results: Among 340 patients (319 atypical ductal hyperplasia, 20 atypical lobular hyperplasia, and 1 mixed), 128 (37.6%) experienced a malignant upgrade, 98 (76.6%) to ductal carcinoma in situ, and 30 (23.4%) to invasive cancer. In multivariate analysis, multifocal atypia (odds ratio [OR], 25.61; 95% confidence interval [CI], 11.20\u201358.55; P&lt;0.001) and Breast Imaging-Reporting and Data System 4c-5 lesions (OR, 11.02; 95% CI, 1.43\u201384.86; P=0.021) were significant predictors. Multifocal atypia showed an 84.4% upgrade rate. Core needle biopsy had higher upgrade rates than vacuum-assisted biopsy (45.2% vs. 20.0%; P&lt;0.001). The upgrade rates decreased from 50% to 25% over the study period (P&lt;0.05).Conclusion: The 37.6% upgrade rate in this tertiary referral cohort exceeded that in Western reports, with multifocal atypia emerging as the strongest predictor. These findings support immediate excision for multifocal atypia while allowing individualized management for unifocal lesions with favorable imaging in Korean tertiary care settings.<\/jats:p>","DOI":"10.14216\/kjco.25363","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:57:27Z","timestamp":1777510647000},"page":"18-27","update-policy":"https:\/\/doi.org\/10.14216\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk stratification for malignant upgrade in breast atypical hyperplasia: a Korean multi-institutional analysis from academic hospitals"],"prefix":"10.14216","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9738-6554","authenticated-orcid":true,"given":"Hyobin","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Surgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7545-024X","authenticated-orcid":true,"given":"Jung Ho","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1848-7801","authenticated-orcid":true,"given":"Min Kyoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4522-9565","authenticated-orcid":true,"given":"Chihwan","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1467-8843","authenticated-orcid":true,"given":"Hocheol","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of AI Health Information Management, Yonsei University Mirae Campus, Wonju, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2583-4218","authenticated-orcid":true,"given":"Se Jeong","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8622-4800","authenticated-orcid":true,"given":"Hoon","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3239-6459","authenticated-orcid":true,"given":"Jae Pak","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2761-3980","authenticated-orcid":true,"given":"Su Hyun","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5816-6519","authenticated-orcid":true,"given":"Eun Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6546-0513","authenticated-orcid":true,"given":"Young-Joon","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Incheon, 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