Nomogram to predict the likelihood of upgrade of atypical ductal hyperplasia diagnosed on a core needle biopsy in mammographically detected lesions

Aims: To estimate the likelihood of the upgrade for atypical ductal hyperplasia (ADH) diagnosed on a core needle biopsy of a mammographically detected lesion. Methods and results: A total of 203 consecutive ADH cases diagnosed on core biopsy in mammographically detected lesions and having subsequent surgical excision were reviewed. The pathological features of ADH were assessed with multivariable logistic regression to predict the likelihood of upgrade for these patients. A nomogram was created using statistically significant variables. A corresponding formula was created to calculate the risk of upgrade. This risk was divided further into low, intermediate and high. A total of 57 (28.1%) cases had upgrade. A nomogram was created that included age, menopausal status, hormone therapy status, personal history of breast cancer, number of involved cores, solid growth pattern, size of largest focus and mammographic mass versus calcifications. The nomogram had an area under the receiver operating characteristic curve of 0.775. Conclusions: We have developed a user-friendly nomogram that uses easily recognized variables to calculate the likelihood of upgrade for ADH. The nomogram could assist the treating surgeon in decision-making, particularly when the patient is at risk for surgical intervention.