To measure discrepancies in diagnoses and recommendations impacting management of proliferative lesions of the breast, a questionnaire
of five problem scenarios was distributed among over 300 practicing pathologists. Of the 230 respondents, 56.5% considered
a partial cribriform proliferation within a duct adjacent to unequivocal ductal carcinoma in situ (DCIS) as atypical ductal
hyperplasia (ADH), 37.7% of whom recommended reexcision if it were at a resection margin. Of the 43.5% who diagnosed the partially
involved duct as DCIS, 28.0% would not recommend reexcision if the lesion were at a margin. When only five ducts had a partial
cribriform proliferation, 35.7% considered it as DCIS, while if ≥20 ducts were so involved, this figure rose to 60.4%. When
one duct with a complete cribriform pattern measured 0.5, 1.5, or 4 mm, a diagnosis of DCIS was made by 22.6, 31.3, and 94.8%,
respectively. When multiple ducts with flat epithelial atypia were at a margin, 20.9% recommended reexcision. Much of these
discrepancies arise from the artificial separation of ADH and low-grade DCIS and emphasize the need for combining these two
under the umbrella designation of ductal intraepithelial neoplasia grade 1 (DIN 1) to diminish the impact of different terminologies
applied to biologically similar lesions.
Keywords Breast - Ductal carcinoma in situ - Hyperplasia - Interobserver variability - Ductal intraepithelial neoplasia