From the Guidelines
Florid ductal lesion, also known as Atypical Ductal Hyperplasia (ADH), is a benign breast condition that requires careful monitoring due to its potential association with an increased risk of developing breast cancer. According to the most recent evidence, ADH is characterized by significant proliferation of epithelial cells within the breast ducts, showing more extensive cell growth than usual ductal hyperplasia but lacking the cellular abnormalities seen in ductal carcinoma in situ 1. The management of ADH typically involves surgical consultation and/or multidisciplinary discussion regarding the benefits and risks of subsequent excision, as recommended by the American College of Radiology 1.
Some key points to consider in the management of ADH include:
- Regular monitoring with follow-up breast examinations and imaging as recommended by a healthcare provider
- Maintenance of routine breast cancer screening appropriate for the patient's age and risk factors
- Consideration of risk-reduction therapy according to the NCCN Breast Cancer Risk Reduction Guidelines for patients with ADH or other high-risk lesions 1
- Surgical excision may be recommended for patients with ADH, particularly if other risk factors are present or if the lesion is image-discordant or indeterminate 1
It is essential to note that the evidence on the management of ADH is varied, and the approach may depend on individual patient factors and risk profiles 1. However, based on the most recent and highest-quality evidence, regular monitoring and maintenance of routine breast cancer screening are crucial for patients with ADH to ensure early detection and treatment of any potential breast cancer.
From the Research
Definition of Florid Ductal Lesion (Atypical Ductal Hyperplasia)
- A florid ductal lesion, also known as atypical ductal hyperplasia (ADH), is a type of breast lesion that exhibits a proliferation of ductal epithelial cells with some atypical features 2.
- It is considered a borderline lesion, with some characteristics of both benign and malignant lesions 3, 4.
- ADH is often associated with an increased risk of developing breast cancer, particularly ductal carcinoma in situ (DCIS) or invasive ductal carcinoma 3, 4.
Characteristics of Florid Ductal Lesions
- Florid ductal lesions are typically characterized by a dense proliferation of ductal epithelial cells with irregular nuclei and cellular pleomorphism 4.
- They may exhibit a variety of architectural patterns, including cribriform, micropapillary, or solid growth patterns 4.
- The lesions may be associated with calcifications, which can be detected on mammography or ultrasound 3.
Differential Diagnosis
- The differential diagnosis of florid ductal lesions includes other proliferative breast lesions, such as ductal hyperplasia without atypia, DCIS, and invasive ductal carcinoma 2, 4.
- The distinction between these lesions can be challenging, and accurate diagnosis requires careful evaluation of cytological and architectural features 4.