Lobular neoplasia on core needle biopsy does not require excision

Abstract

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.

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

“…If cases with discordant imaging and pathology are included in our upgrade category, our upgrade percentage would be comparable to that published in other studies. The significance of radiologic-pathologic discordance has been demonstrated in recent studies by Menon 33 and Nagi et al 35 Similarly, discordance was the major cause for an upgrade in our study. Findings were considered discordant when (1) the radiologic finding was a mass and lobular neoplasia was the pathologic diagnosis on core biopsy or (2) the radiology showed suspicious calcifications that were not represented in the core biopsy specimen.…”

“…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.…”

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

“…When we correlated our microscopic findings with the radiographic targets, we found a trend toward a higher upgrade rate when LCIS represented the targeted abnormality versus when LCIS was present as an incidental finding (18% [2 of 11 cases] versus 4% [1 of 24 cases], respectively). Although our finding of a 4% pathologic upgrade rate was in line with that of findings by Nagi and colleagues, 31 the difference from the pathologic upgrade rate when LCIS represented the targeted lesion was not statistically significant in our study.…”

“…The reported frequency of finding calcifications present within LCIS/ALH in needle core biopsy samples ranges from 8% to 41%. 6,7,9,18,25,31,32 In our series, we found calcifications to be present within LCIS in a significant percentage of cases (38 of 61; 62%), and that frequency was even higher among cases specifically targeting calcifications (36 of 50; 72%). Calcifications were present exclusively in LCIS in 10 of 61 cases (16%), and that finding was slightly more frequent among cases targeted for calcifications (10 of 50; 20%).…”

“…Karabakhtsian et al 9 reported that cases of LCIS/ALH with neoplastic epithelial calcifications, which were presumed to represent the radiographic target in their study, showed a higher rate of pathologic upgrade on follow-up excision. Nagi et al 31 studied 45 patients with LCIS/ALH on core biopsy who underwent follow-up excision. All cases (100%) of LCIS/ALH in their study were determined to be incidental, and cases of type B LCIS and pleomorphic LCIS were excluded.…”