Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings.

Liberman, Laura; Sama, Michelle P.; Susnik, Barbara; Rosen, Peter; LaTrenta, Linda R.; Morris, Elizabeth A.; Abramson, A F; Dershaw, D. David

doi:10.2214/ajr.173.2.10430122

Cited by 191 publications

(114 citation statements)

References 30 publications

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“…However, the literature documents this rate as ranging anywhere from 0.5% to 8% in breast biopsies, with this discrepancy representing a gradual increase extending up to the present day. [3][4][5][6]10,14,[20][21][22] This variation and the increased incidence noted in recent years is likely correlated with improvements in breast imaging and the subsequent increase in the frequency of CNB, as well as the greater amount of tissue acquired through the larger bore vacuum suction needles.…”

Section: Discussionmentioning

confidence: 99%

“…A study by Liberman et al revealed similar findings with regard to cases with LCIS and detailed 3 situations necessitating FSE: 1) the presence of histologic features overlapping those of DCIS, 2) the identification of a coexisting high-risk lesion (as mentioned earlier), and 3) a discordance in findings on imaging compared with the corresponding histology. 21 Because of the uncertainty regarding the biologic behavior of LN, controversies exist with regard to its proper management. Data from the current study indicate that, in the absence of radiologic discrepancies and excluding LN with larger cells and proliferative activity, the classic forms of LN can be managed with clinical surveillance without the need for surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

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Lobular neoplasia on core needle biopsy does not require excision

Nagi

O'Donnell

Tismenetsky

et al. 2008

Cancer

106

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BACKGROUND. Lobular neoplasia (LN), encompassing atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), is often an incidental finding on core needle biopsies (CNBs) performed in instances of radiologic densities and/or calcifications. Because LN is generally considered a risk factor for breast carcinoma, the utility of subsequent excision is controversial. METHODS. The authors' database yielded 98 cases of LCIS and/or ALH. Cases containing LN accompanied by a second lesion mandating excision (eg, radial scar, atypical ductal hyperplasia [ADH]) and those failing to meet strict diagnostic criteria for LN (eg, atypical cells, mitoses, single‐cell necrosis) were excluded. Radiographic calcifications were correlated with their histologic counterparts in terms of size, number, and pattern. RESULTS. Ninety‐one biopsies were performed for calcifications and 7 were performed for mass lesions. The ages of the patients ranged from 35 to 82 years. Fifty‐three patients were followed radiologically without excision, 42 of whom had available clinicoradiologic information. The 45 patients who underwent excision were without disease at follow‐up periods ranging from 1 to 8 years. Of these 45 patients, 42 (93%) had biopsy results demonstrating only LN. The remaining 3 patients had biopsies with the following findings: ADH in 1 biopsy, residual LCIS and a separate minute focus of infiltrating lobular carcinoma (clearly an incidental finding) in the second biopsy, and ductal carcinoma in situ admixed with LCIS in the third biopsy (a retrospective examination performed by 2 blinded breast pathologists revealed foci of atypical cells and mitoses). CONCLUSIONS. Excision of LN is unnecessary provided that: 1) careful radiographic‐pathologic correlation is performed; and 2) strict histologic criteria are adhered to when making the diagnosis. Close radiologic and clinical follow‐up is adequate. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lobular neoplasia on core needle biopsy does not require excision

Nagi

O'Donnell

Tismenetsky

et al. 2008

Cancer

106

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“…The number of cases included in previously published studies (combining atypical lobular hyperplasia and lobular carcinoma in situ) varies from less than 10 up to 92 cases of lobular neoplasia followed by immediate excision. [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] In comparison, our study includes a relatively high number of cases (87 cases of lobular neoplasia followed by immediate excision). Another limitation in our study and others is that it is retrospective and may suffer from selection bias regarding the patients that underwent excision.…”

Section: Discussionmentioning

confidence: 99%

Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary

Hwang

Barke

Mendelson³

et al. 2008

Modern Pathology

104

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Standardized recommendations for the management of lobular neoplasia in core biopsy specimens are not established. The aim of our study was to define morphologic features of lobular neoplasia in core biopsies that predict the finding of ductal carcinoma in situ or invasive carcinoma in the subsequent excisional specimen. We reviewed 333 cases of atypical lobular hyperplasia or lobular carcinoma in situ without ductal carcinoma in situ or invasive carcinoma diagnosed in core biopsies from 1996 to 2006. Subsequent excision was performed in 41% (136/333) of cases, including atypical lobular hyperplasia (n ¼ 48), lobular carcinoma in situ (n ¼ 39), and lobular neoplasia associated with atypical ductal hyperplasia (n ¼ 49). Upgrades were identified in 2% (1/48) of atypical lobular hyperplasia, 23% (9/39) of lobular carcinoma in situ, and 27% (13/49) of lobular neoplasia associated with atypical ductal hyperplasia cases. When further analyzed, the upgraded cases of lobular carcinoma in situ were associated with radiologic-pathologic discordance in 6/9 cases and with nonclassic pathology (two lobular carcinoma in situ with necrosis and one pleomorphic lobular carcinoma in situ) in the remaining three cases. The frequency of upgrade was 11% (3/26) in classic lobular carcinoma in situ, and 46% (6/13) in nonclassic types (pleomorphic or with necrosis). After excluding cases with discordant imaging/ pathology, there was a 5% upgrade in our excisional specimens. After excluding cases where the upgrade was associated with nonclassic morphology, the upgrade in our study was 1%. Our results suggest that atypical lobular hyperplasia and classic lobular carcinoma in situ with concordant radiology and pathology can be appropriately managed with clinical follow-up without surgery.

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“…The detection of both ADH and LN on core biopsy has been found to be associated with the diagnosis of carcinoma on follow-up excision in many studies 31,34,37 and has been considered an additional indication for surgical biopsy. In the current study, the rate of detection of malignant disease on follow-up excisional biopsy was highest in the ADH ϩ LN group (33%) compared with the other two study groups.…”

Section: Discussionmentioning

confidence: 99%