Atypical Ductal Hyperplasia and Lobular Neoplasia: Update and Easing of Guidelines

AJR Am J Roentgenol. 2020 Feb;214(2):265-275. doi: 10.2214/AJR.19.21991. Epub 2019 Dec 11.


OBJECTIVE. Atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and lobular carcinoma in situ (LCIS) are among high-risk lesions that have been previously recommended for surgical excision when diagnosed on core needle biopsy. Recent studies have examined whether imaging surveillance is a reasonable alternative to surgical management for these lesions. This article synthesizes the evidence regarding management of atypical hyperplasia and LCIS diagnosed on core needle biopsy and clinical implications of these diagnoses on future breast cancer risk as well as highlights areas of further research needed to improve practice guidelines for these high-risk lesions. CONCLUSION. Although surgical excision is still recommended after diagnosis of ADH on core needle biopsy, in specific circumstances ALH and LCIS can safely be managed by imaging surveillance.

Keywords: atypical ductal hyperplasia; atypical lobular hyperplasia; lobular carcinoma in situ; surgical excision; surveillance.

Publication types

  • Review

MeSH terms

  • Biopsy, Large-Core Needle
  • Breast Carcinoma In Situ / diagnostic imaging
  • Breast Carcinoma In Situ / pathology*
  • Breast Carcinoma In Situ / surgery
  • Breast Neoplasms / diagnostic imaging
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / surgery
  • Carcinoma, Intraductal, Noninfiltrating / diagnostic imaging
  • Carcinoma, Intraductal, Noninfiltrating / pathology*
  • Carcinoma, Intraductal, Noninfiltrating / surgery
  • Female
  • Humans
  • Mammography
  • Practice Guidelines as Topic*
  • Precancerous Conditions / diagnostic imaging
  • Precancerous Conditions / pathology*
  • Precancerous Conditions / surgery