Progress Toward Non-operative Management of Atypical Ductal Hyperplasia

Atypical Ductal Hyperplasia (ADH) is a benign but high-risk lesion of the breast for which surgical excision remains the standard of care. Multiple investigations have attempted to identify a cohort of patients with ADH who could safely avoid surgical excision with low risk of a missed in situ or invasive carcinoma.

MRI appears to be a useful adjunct in this process, but further research is needed to determine the most effective method of utilizing this technology for identification of a non-surgical cohort. Multiple criteria have been developed utilizing clinical, pathologic, and imaging characteristics to achieve this goal. Criteria published by Nguyen and colleagues in 2011 has been studied with up to 15 years of follow-up and appears to be a safe model for stratification of patients with ADH.

ADH appears to be safe to observe in some women, but further work will be needed determine the best model for stratifying patients that is feasible to implement outside of select centers.