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International Journal of Surgical Oncology
Volume 2012, Article ID 297832, 5 pages
Review Article

Atypical Ductal Hyperplasia at the Margin of Lumpectomy Performed for Early Stage Breast Cancer: Is there Enough Evidence to Formulate Guidelines?

1Division of General Surgery, Department of Surgery, UCSD Medical Center, University of California, San Diego, CA 92103, USA
2Division of Surgical Pathology and Cytopathology, Department of Pathology, UCSD Medical Center, University of California, San Diego, CA 92093, USA
3Division of Surgical Oncology and Breast Surgery, Department of Surgery, UCSD Moores Cancer Center, University of California, San Diego, CA 92093, USA

Received 10 August 2012; Accepted 29 October 2012

Academic Editor: Sheldon Marc Feldman

Copyright © 2012 Jennifer L. Baker et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Negative margins are associated with a reduced risk of ipsilateral breast tumor recurrence (IBTR) in women with early stage breast cancer treated with breast conserving surgery (BCS). Not infrequently, atypical ductal hyperplasia (ADH) is reported as involving the margin of a BCS specimen, and there is no consensus among surgeons or pathologists on how to approach this diagnosis resulting in varied reexcision practices among breast surgeons. The purpose of this paper is to establish a reasonable approach to guide the treatment of ADH involving the margin after BCS for early stage breast cancer. Methods. the published literature was reviewed using the PubMed site from the US National Library of Medicine. Conclusions. ADH at the margin of a BCS specimen performed for early stage breast cancer is a controversial pathological diagnosis subject to large interobserver variability. There is not enough data evaluating this diagnosis to change current practice patterns; however, it is reasonable to consider reexcision for ADH involving a surgical margin, especially if it coexists with low grade DCIS. Further studies with longer followup and closer attention to ADH at the margin are needed to formulate treatment guidelines.