Atypical Lobular Hyperplasia and Classic Lobular Carcinoma In Situ Can Be Safely Managed Without Surgical Excision

Laws, Alison; Katlin, Fisher; Nakhlis, Faina; Chikarmane, Sona A.; Schnitt, Stuart J.; King, Tari A.

doi:10.1245/s10434-021-10827-z

Cited by 18 publications

(6 citation statements)

References 20 publications

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“…Two of the studies examined malignancy upgrade rates after delayed surgical management (performed >6 months after NCB) at the biopsy site; 1.7% DCIS (median) (range 0%–2.7%) and 0% invasive cancer (Table 4). Studies of AS of lobular neoplasia, which includes ALH and LCIS, have also shown low upgrade to malignancy rates of 1%–6% at the NCB site 11,17 . Our study adds to the increasing evidence indicating that ALH diagnosed via NCB has been safely managed with AS and is a preferred alternative to prompt excision, with surgery management recommended to patients whose lesions progress radiographically.…”

Section: Discussionmentioning

confidence: 55%

“…Studies of AS of lobular neoplasia, which includes ALH and LCIS, have also shown low upgrade to malignancy rates of 1%-6% at the NCB site. 11,17 Our study adds to the increasing evidence indicating that ALH diagnosed via NCB has been safely managed with AS and is a preferred alternative to prompt excision, with surgery management recommended to patients whose lesions progress radiographically.…”

Section: Discussionmentioning

confidence: 74%

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Outcomes of atypical lobular hyperplasia managed by active surveillance or immediate surgery

Han,

Lee,

Dodelzon

et al. 2024

World j. surg.

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BackgroundAtypical lobular hyperplasia (ALH) is typically diagnosed via needle core biopsy (NCB) and is commonly removed surgically in light of upgrade to malignancy rates of 1%–5%. As studies on radiographic outcomes of ALH managed by active surveillance (AS) are limited, we investigated the upgrade rates of surgically excised ALH as well as radiographic progression during AS.MethodsIn this retrospective study, 125 patients with 127 ALH lesions diagnosed via NCB at Weill Cornell Medicine from 2015 to 2021 were included. The upgrade rate to cancer was determined for patients who had surgical management ≤6 months after biopsy. Among patients with ALH managed by AS, we investigated radiographic progression on 6‐month interval imaging.ResultsOf 127 ALH lesions, 75% (n = 95) were immediately excised and 25% (n = 32) were observed under AS. The upgrade rate of immediately excised ALH was 2.1% (n = 2; invasive ductal carcinoma [IDC], T1N0 and IDC, and T1Nx). In the AS cohort, no ALH lesions progressed radiographically during the follow‐up period of 22.5 months (median), with all remaining stable (50%, n = 16), resolving (47%, n = 15), or decreasing in size (3%, n = 1).ConclusionsIn this study, NCB‐diagnosed ALH had a low upgrade to malignancy rate (2.1%), and no ALH lesions managed by AS progressed radiographically during the follow‐up period of 22.5 months. These results support AS as the favorable option for patients with pure ALH on biopsy, with surgical excision for lesions that progress on surveillance.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 74%

Outcomes of atypical lobular hyperplasia managed by active surveillance or immediate surgery

Han,

Lee,

Dodelzon

et al. 2024

World j. surg.

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“…Metovic et al reported 28.3% in ALH, LCIS, and high-grade LN cases [ 18 ], whereas Singh et al reported 4% upgrade in classic LCIS, which is similar to our own observations [ 19 ]. Laws et al have reported a series of 77 patients with 78 LN lesions, primarily treated with conservative management rather than surgical excision [ 20 ]. They demonstrated a 6.2% risk of conservative management failure.…”

Section: Discussionmentioning

confidence: 99%

Management of Lobular Neoplasia Diagnosed by Core Biopsy

et al. 2023

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Lobular neoplasia (LN) involves proliferative changes within the breast lobules. LN is divided into lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH). LCIS can be further subdivided into three subtypes: classic LCIS, pleomorphic LCIS, and LCIS with necrosis (florid type). Because classic LCIS is now considered as a benign etiology, current guidelines recommend close follow-up with imaging versus surgical excision. The goal of our study was to determine if the diagnosis of classic LN on core needle biopsy (CNB) merits surgical excision. This is a retrospective, observational study conducted at Mount Auburn Hospital, Cambridge, MA, from May 17, 2017, through June 30, 2020. We reviewed the data of breast biopsies conducted at our hospital over this period and included patients who were diagnosed with classic LN (LCIS and/or ALH) and excluded patients having any other atypical lesions on CNB. All known cancer patients were excluded. Of the 2707 CNBs performed during the study period, we identified 68 women who were diagnosed with ALH or LCIS on CNB. CNB was performed for an abnormal mammogram in the majority of patients (60; 88%) while 7(10.3%) had an abnormal breast magnetic resonance imaging study (MRI), and 1 had an abnormal ultrasound (US). A total of 58 patients (85%) underwent excisional biopsy, of which 3 (5.2%) showed malignancy, including 2 cases of DCIS and 1 invasive carcinoma. In addition, there was 1 case (1.7%) with pleomorphic LCIS and 11 cases with ADH (15.5%). The management of LN found on core biopsy is evolving, with some advocating surgical excision and others recommending observation. Our data show a change in diagnosis with excisional biopsy in 13 (22.4%) of patients with 2 cases of DCIS, 1 invasive carcinoma, 1 pleomorphic LCIS, and 9 cases of ADH, diagnosed on excisional biopsy. While ALH and classic LCIS are considered benign, the choice of ongoing surveillance versus excisional biopsy should be made with shared decision making with the patient, with consideration of personal and family history, as well as patient preferences.

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“…51 Few small prospective studies of observation with limited follow-up have been published and do not seem to be generalizable to different practice settings. [51][52][53][54][55] For instance, Middleton et al 52 published a series of 104 patients with pure lobular…”

Section: ■ Guideline Disagreementmentioning

confidence: 99%

“…Finding cases of cancer with a screening test (such as a mammography) that will never cause any symptoms Overtreatment Interventions that do not benefi t the patient or where the risk of harm from the intervention is likely to outweigh any benefi t the patient will receive neoplasia followed for a median of 3.4 years: 5 patients were subsequently diagnosed with breast cancer (3 of 5 at an unrelated site). Laws et al 53 noted that in their high-risk clinic where MRI screening is not routinely recommended and following multidisciplinary discussion of all benign high-risk lesions, atypical lobular hyperplasia and classic lobular carcinoma in situ have been safely managed thus far without surgical excision based on 80 patients with pure lobular neoplasia and median follow-up of 27 months. 53 Another study examined 478 patients with 483 atypical ductal hyperplasia lesions; 309 were observed and 174 underwent excision.…”

Section: Overdiagnosismentioning

confidence: 99%

Surgical de-escalation: Are we ready for ‘observation’ of benign high-risk breast lesions found on core needle biopsy?

Pederson

Pratt

Calhoun

2023

CCJM

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Atypical Lobular Hyperplasia and Classic Lobular Carcinoma In Situ Can Be Safely Managed Without Surgical Excision

Cited by 18 publications

References 20 publications

Outcomes of atypical lobular hyperplasia managed by active surveillance or immediate surgery

Outcomes of atypical lobular hyperplasia managed by active surveillance or immediate surgery

Management of Lobular Neoplasia Diagnosed by Core Biopsy

Surgical de-escalation: Are we ready for ‘observation’ of benign high-risk breast lesions found on core needle biopsy?

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