Observation versus excision of lobular neoplasia on core needle biopsy of the breast

Schmidt, Hank; Arditi, Brittany; Wooster, Margaux; Weltz, Christina; Margolies, Laurie; Bleiweiss, Ira J.; Port, Elisa; Jaffer, Shabnam

doi:10.1007/s10549-017-4629-2

Cited by 33 publications

(24 citation statements)

References 28 publications

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“…8,13,14,27 Other studies report upgrade rates from 0%-4%, and oppose routine excision. 9,16,17,28 In this study, all nine of the upgraded lesions were initially reported as ALH on CNB, while none of the LCIS lesions were upgraded on final excision. This is not in-keeping with published reports that suggest the risk of upgrade for LCIS 2-4 times higher than that of ALH.…”

Section: Discussionmentioning

confidence: 59%

“…7,8 The debate centers around the possible risk of pathologic upgrade of the lesion following diagnostic excision. 9 Unfortunately, there is significant heterogeneity in the literature among reported upgrade rates, which range from 0% to 40%. [10][11][12][13][14][15][16][17][18][19][20] Consequently, there is a lack of consensus around management, with various studies advocating for; surveillance, 16,17 excision, 13,14 or a combination of both.…”

Section: Introductionmentioning

confidence: 99%

“…18 In recent years improving imaging techniques, increased screening and increased use of MRI in high-risk surveillance has resulted in an increase in the identification of breast lesions warranting biopsy. 9 As technology continues to improve, these numbers will likely continue to rise, resulting in an increase in the rate of LIN diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Lobular intraepithelial neoplasia: Outcomes and optimal management

et al. 2020

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Introduction: Lobular neoplasia is a term encompassing both atypical lobular hyperplasia and lobular carcinoma in situ. These pathological findings are of uncertain malignant potential and predispose to a higher lifetime risk of breast cancer. Debate surrounds the management of such lesions, with the rationale for diagnostic excision based on the possibility of upgrading to malignancy. In this study, we report the upgrade rate of these lesions and risk of subsequent development of breast cancer. Methods: This is a retrospective review of a prospectively maintained data base of all biopsies of breast screening-detected abnormalities in a single Irish breast-screening unit. We included all patients with lobular neoplasia on core needle biopsy who underwent diagnostic excision from 2005 to 2012. We excluded those who had concurrent high-risk lesions on biopsy. End points included upgrade rate and subsequent diagnosis of malignancy on follow-up. Results: During the study period, 66 patients met criteria for inclusion, with a mean age of 53.74 years. Upgrade rate following excision was 13.64% (n = 9/66). Of those not upgraded, 7.02% (n = 4/57) were subsequently diagnosed with malignancy. Median time to diagnosis was 59.61 months (range = 10.5-124.4). Conclusion: There is a significant rate of upgrade following diagnostic excision of lobular neoplasia, supporting the practice of diagnostic excision. There is an increased lifetime risk of breast cancer for women with a diagnosis of lobular neoplasia, with many of these cancers occurring outside the standard five-year monitoring period, suggesting a potential benefit in extending surveillance.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lobular intraepithelial neoplasia: Outcomes and optimal management

et al. 2020

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Section: Discussionmentioning

confidence: 99%

“…On the contrary, classical lobular neoplasia forms are known to have a different biological behavior in terms of local recurrence and development of synchronous or subsequent breast cancer than the high-grade variants (King et al 2015; King and Reis-Filho 2014; Wen and Brogi 2018; Rageth et al 2016Rageth et al , 2019Schmidt et al 2018). Upgrade rate to in situ or invasive cancer in open excision specimens has been conflictingly reported in the literature varying from 0 to 25% in some papers up to 50% (Rageth et al 2016(Rageth et al , 2019Schmidt et al 2018). No association with common clinical risk factors as positive family history or age can be linked to clinical behavior, and until now, no single histopathological factor could predict upgrade or development of concurrent or subsequent breast cancer (King et al 2015;Rageth et al 2016Rageth et al , 2019.…”

Section: Discussionmentioning

confidence: 99%

Inter-observer reproducibility of classical lobular neoplasia (B3 lesions) in preoperative breast biopsies: a study of the Swiss Working Group of breast and gynecopathologists

Moskovszky

Berger

Fleischmann

et al. 2020

J Cancer Res Clin Oncol

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Purpose Classical type of lobular neoplasia (LN) spans a spectrum of disease, including atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), classical lobular neoplasia (LN), and the three-tiered classification of lobular intraepithelial neoplasia (LIN-1,-2,-3). This study addressed inter-observer variability of classical lobular neoplasias (LN) (B3 lesions) in preoperative breast biopsies among breast and gynecopathologists Methods A retrospective, observational, cross-sectional study was conducted. 40 preoperative digital images of breast core/ vacuum biopsies were analyzed by eight experienced breast-and gynecopathologists. Evaluation criteria were ALH, LCIS, LN classic, LIN-1, LIN-2, LIN-3, focal B3 (one focus), extensive B3 (> one focus). Kappa-index and Chi-square tests were used for statistics. Digital scanned slides were provided to each participant. Agreement between the categories was defined as at least six of eight (cut-off 75%) concordant diagnoses. Results The highest agreement between eight pathologists was reached using the category lobular neoplasia (LN, classical), 26/40 (65%) cases were diagnosed as such. Agreements in other categories was low or poor: 12/40 (30%) (ALH), 9/40 (22%) (LCIS), 8/40 (20%) (LIN-1), 8/40 (20%) (focal B3), 3/40 (7.5%) (LIN-2), and 2/40 (5%) (extensive B3). Chi-square-test (classical LN versus the other nomenclatures) was significant (p = 0.001137). Conclusion Our data suggest that among Swiss breast pathologists, the most reproducible diagnosis for B3 lobular lesions is the category of classical LN. These data further support lack of consistent data in retrospective studies using different terminologies. Validation of reproducible nomenclature is warranted in further studies. This information is useful especially in view of retro-and prospective data analysis with different diagnostic categories.

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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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Observation versus excision of lobular neoplasia on core needle biopsy of the breast

Abstract: Surgical excision of LN yields a low upgrade rate when careful consideration is given to radiologic/pathologic correlation to exclude cases of discordance. Observation with interval breast imaging is a reasonable alternative for most cases.

Cited by 33 publications

References 28 publications

Lobular intraepithelial neoplasia: Outcomes and optimal management

Lobular intraepithelial neoplasia: Outcomes and optimal management

Inter-observer reproducibility of classical lobular neoplasia (B3 lesions) in preoperative breast biopsies: a study of the Swiss Working Group of breast and gynecopathologists

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

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