Upgrade Rate of Atypical Ductal Hyperplasia: Ten Years Experience and Predictive Factors.

BACKGROUND: Atypical ductal hyperplasia (ADH) is a benign epithelial proliferative lesion with histologic features resembling those seen in low grade ductal carcinoma in situ (DCIS). Surgical excision of the biopsy site is the standard management approach. The objective of this study was to determine the upgrade rate from ADH on stereotactic breast biopsies to DCIS or invasive carcinoma (IC) in our institution. We also sought to identify clinical, pathologic and radiologic predictive factors associated with risk of upgrade. MATERIALS AND METHODS: Clinical charts, mammograms and pathology reports were reviewed for all women with a stereotactic breast biopsy showing ADH and subsequent surgery at our institution between 2008 and 2018. When available, mammograms were re-reviewed by a radiologist for this study. RESULTS: 295 biopsies were analyzed in 290 patients. Mean age was 56 y old. Upgrade rate was 10.5% of which 7.5% were DCIS and 3.1% IC. Mammograms were reviewed by a radiologist in 161 patients from 2013 to 2018. In this subset of patients, the rate of upgrade was 8.7% (4.35% DCIS and 4.35% IC). A statistically significant difference he largest size of the microcalcification clusters on mammogram was observed between the upgraded and the non-upgraded subgroups (14.2 mm versus 8.9 mm, P = 0.03) CONCLUSIONS: The evaluation of the largest size of microcalcification clusters on mammogram as a cut-off feature could be considered to choose between an observational versus a surgical approach. This large series provides contemporary data to assist informed decision making regarding the treatment of our patients.

Unequal chances: ex ante fairness and individual control.

Unequal financial outcomes often originate from unequal chances. Yet, compared to outcomes, little is known about how individuals perceive unequal distributions of chances. We investigate empirically the role of different sources of unequal chances in shaping inequality perceptions. Importantly, we do so from an ex ante perspective-i.e., before the chances are realized-which has rarely been explored. In an online survey, we asked uninvolved respondents to evaluate ex ante the fairness of unequal allocations of chances. We varied the source of inequality of chances, using a comprehensive range of factors which resemble several real world situations. Respondents also evaluated how much control individuals hold over the distribution of chances. Results show that different sources generate different ex ante perception of fairness. That is, unequal chances based on socioeconomic and biological factors, such as gender, family income and ethnicity, are evaluated to be unfair relative to the same chances based on effort, knowledge, and benevolence. Results also show that, for most individuals, there is a positive correlation between perceived control of a factor and fairness of unequal chances based on that factor. Luck appears to be an exception to this correlation, ranking as high in fairness as effort, knowledge, and benevolence, but similarly low in individual control as ethnicity, family income, and gender.