Outcomes on Excision and Clinical Follow-up of Isolated Atypical Apocrine Adenosis Diagnosed on Core Needle Biopsy: A Multi-institutional Study

Context.— Atypical apocrine adenosis (AAA) is a rare breast lesion defined as presence of cytologic atypia in apocrine adenosis. World Health Organization Classification of Tumours, 5th edition, defines cytologic atypia as at least 3-fold variation in nuclear size and prominent nucleoli. Currently, owing to the rarity of the lesion, the clinical behavior of AAA is not well understood. Objective.— To further investigate the risk of upgrade to malignant histology on follow-up excision after a diagnosis of isolated atypical apocrine adenosis (iAAA) on core needle biopsy (CNB). Design.— We identified 22 female patients with diagnosis of iAAA on CNBs across 3 institutions between 2000 and 2024, with an average age of 58 years. The most common indication for CNB was presence of a mass. We reviewed pathology reports and available histology slides of CNBs and subsequent surgical excisions. Results.— Of 22 patients, 17 underwent surgical excision and 5 were followed up with mammogram for an average of 38 months. The diagnosis for 2 of 17 patients (12%) who underwent excision was upgraded to malignancy (ductal carcinoma in situ), 3 had atypical ductal hyperplasia (1 with AAA), and 2 additional cases had residual iAAA. iAAA was the target lesion in 7 of 21 cases (33%); among these 7 cases, 5 presented with a mass: 2 of 5 (40%) were upgraded to DCIS and 1 of 5 had residual iAAA. The 5 patients who were followed up did not have any adverse outcomes. Conclusions.— We recommend surgical excision of iAAA when found on CNB, especially when the target lesion is a mass. However, larger studies are necessary to further understand this entity.