Lobular neoplasia: Core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features

Londero, Viviana; Zuiani, Chiara; Linda, Anna; Vianello, Elena; Furlan, Alessandro; Bazzocchi, Massimo

doi:10.1016/j.breast.2008.05.007

Cited by 49 publications

(41 citation statements)

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“…Based on the recent reports, the positive predictive value for malignancy is 44-61% for LN seen as BIRADS 3 tumors and 85-90% for LN viewed as BIRADS 4 lesion [47,48]. It is also increased for LCIS and tumors larger than 2 cm when compared to ALH and smaller lesions: 57.1% vs. 7.1%, and 100% vs. 31.2%, respectively [49]. Interestingly, there was significantly increased risk of IBC in the site of mass--forming LN reported in the study from Nottingham University Hospital, but the authors claimed that it was the result of biopsy missing the radiologically symptomatic lesion next to incidental LN [44].…”

Section: Methodsmentioning

confidence: 99%

Lobular neoplasia found on breast biopsy: marker of increased risk of malignancy or direct pre-cancerous lesion?

Szynglarewicz¹,

Matkowski²,

Hałoń³

et al. 2011

Folia Histochem Cytobiol.

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Section: Methodsmentioning

confidence: 99%

Lobular neoplasia found on breast biopsy: marker of increased risk of malignancy or direct pre-cancerous lesion?

Szynglarewicz¹,

Matkowski²,

Hałoń³

et al. 2011

Folia Histochem Cytobiol.

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“…Upgrades were noted with all needle gauges and biopsy devices. There were several upgrades reported with vacuum-assisted Il-G probes and more than 10 cores of tissue, but with a vacuum-assisted 8 gauge probe (providing larger, less fragmented and less hematic specimens for histological evaluation), and 11-17 probes are associated to higher diagnostic accuracy and lower risk of underestimation (12,19) Although many studies focused their attention on atypical ductal hyperplasia or ductal carcinoma in situ underestimation at VABB (6; 21-23), very few authors examined the efficacy of this technique in the characterization of ALH and LCIS lesions (24). Therefore, standardized recommendations for the management of lobular carcinoma in situ or atypical lobular hyperplasia diagnosed on core biopsy have not been established because of disagreement (10).…”

Section: Discussionmentioning

confidence: 99%

“…Londero and Foster recommend surgical excision in case of percutaneous lobular neoplasia diagnosis because of its role as a precursor of breast cancer and because of the known risk of underestimation (12,18). Mahoney recommend that excisional surgical biopsy be performed in cases of lobular neoplasia diagnosed at stereotactic core needle biopsy to exclude a coexistent intraductal or invasive carcinoma that may be present in 19% of these patients (20).…”

Section: Discussionmentioning

confidence: 99%

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Underestimation of Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Stereotaxic 11-Gauge Vacuum-Assisted Breast Biopsy

et al. 2013

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The aims of this study are to determine the frequency of diagnosis of atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) at stereotaxic-guided ll-gauge vacuum-assisted breast biopsy (VABB) and to assess the rate of underestimation of these at subsequent surgical excision and follow-up. Moreover, we aimed to define clinical, radiological and histological features of nonpalpable lesions in core biopsies that predict the lesion upgrade. Retrospective review of ll-gauge VABB was performed to identify the underestimation rate of nonpalpable lesions diagnosed as ALH or LCIS at VABB. Thirteen cases of ALH and 36 cases of LCIS were sent to surgery, 29 cases of ALH and 14 cases of LCIS were sent to follow-up. The clinical, mammographic and histologic features were assessed. The correlation between mammographic BI-RADS score and histological B-c1assification for both ALH and LCIS lesions were performed by Pearson's test. Of 1,765 patients enrolled, lobular lesions (ALH and! or LCIS) occurred in 82 cases, and underestimation arose in 9 (10.9%). Two cases of underestimated ALH were upgraded to invasive lobular carcinoma and one to invasive ductal carcinoma. One case of underestimated LCIS was upgraded to ductal carcinoma in situ, two to invasive ductal carcinoma and three to invasive lobular carcinoma. The histology of the core and surgical specimens were compared. A significant difference was seen in the BI-RADS score (4-5 in 91% of underestimated lesions), and the size of the lesions (2: 1.5 em) for underestimated cases versus accurately diagnosed cases (p1.5cm, co-presence of high-risk lesions in the sample, signs of ductal involvement, high histological grading for atypia and follow-up in the other cases. Surgery is recommended in all cases of LCIS:Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), lesions that are also referred to under the umbrella heading of 'lobular neoplasia' (LN) (1), occur relatively infrequently in the breast. However, problems and controversies surrounding the most appropriate terminology and

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“…2013;137:927-935; doi: 10.5858/ arpa.2012-0297-OA) L obular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) are infrequent findings in needle core biopsy samples, occurring in approximately 0.5% to 4% of needle core biopsies. [1][2][3][4][5][6][7][8][9][10] Finding LCIS/ALH as the primary, most clinically significant, pathologic diagnosis on core biopsy is even more uncommon. Currently, the surgical management of patients with a primary diagnosis of LCIS or ALH in needle core biopsy samples is controversial and without consensus.…”

mentioning

confidence: 99%

Pathologic Upgrade Rates on Subsequent Excision When Lobular Carcinoma In Situ Is the Primary Diagnosis in the Needle Core Biopsy With Special Attention to the Radiographic Target

D’Alfonso

Wang

Chiu

et al. 2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Lobular carcinoma in situ (LCIS) as the primary pathologic diagnosis in a needle core biopsy is an infrequent finding, and the management of patients in this setting is controversial. Objective.—To determine the rate of pathologic upgrade (defined as the presence of a clinically more-significant lesion in the subsequent excision) in patients with a primary pathologic diagnosis of LCIS in the needle core biopsy. Design.—Patients with a primary diagnosis of LCIS in a needle core biopsy who underwent subsequent excision were identified. Core biopsies containing a concurrent high-risk lesion and cases with radiologic-pathologic discordance were excluded. The presence of selected microscopic features in the needle core biopsy was correlated with pathologic upgrade. Microscopic findings were correlated with the radiographic target in the needle core biopsy. Results.—Sixty-one women with primary LCIS in their needle core biopsy showed a 10% pathologic upgrade rate. The percentage of cores involved by LCIS was significantly associated with pathologic upgrade (P= .04), whereas the remaining measured parameters were not. When LCIS represented the radiographic target, the pathologic upgrade rate was 18%, whereas when it was an incidental finding, the pathologic upgrade rate was 4%. Conclusions.—It may be reasonable for patients with primary, yet incidental, LCIS on needle core biopsy to be managed in a nonsurgical fashion. Larger studies are needed to confirm our findings.

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Lobular neoplasia: Core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features

Cited by 49 publications

References 50 publications

Lobular neoplasia found on breast biopsy: marker of increased risk of malignancy or direct pre-cancerous lesion?

Lobular neoplasia found on breast biopsy: marker of increased risk of malignancy or direct pre-cancerous lesion?

Underestimation of Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Stereotaxic 11-Gauge Vacuum-Assisted Breast Biopsy

Pathologic Upgrade Rates on Subsequent Excision When Lobular Carcinoma In Situ Is the Primary Diagnosis in the Needle Core Biopsy With Special Attention to the Radiographic Target

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