scholarly journals Factors Indicating Surgical Excision in Classical Type of Lobular Neoplasia of the Breast

Breast Care ◽  
2021 ◽  
pp. 1-8
Author(s):  
Constanze Elfgen ◽  
Christoph Tausch ◽  
Ann-Katrin Rodewald ◽  
Uwe Güth ◽  
Christoph Rageth ◽  
...  
Keyword(s):  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Treatment Options ◽  
Lobular Carcinoma ◽  
Disease Free Survival ◽  
Surgical Excision ◽  
Careful Consideration ◽  
Lobular Neoplasia ◽  
Classical Type

<b><i>Purpose:</i></b> Classical type of lobular neoplasia (LN) encompassing both atypical lobular hyperplasia and classical lobular carcinoma in situ of the breast is a lesion with uncertain malignant potential and has been the topic of several studies with conflicting outcome results. The aim of our study was to clarify outcome-relevant factors and treatment options of classical LN. <b><i>Methods:</i></b> We performed a pathological re-evaluation of the preoperative biopsy specimens and a retrospective clinical and radiological data analysis of 160 patients with LN from the Breast Center Zurich. Open surgery was performed in 65 patients, vacuum-assisted biopsy (VAB) in 79 patients, and surveillance after breast core needle biopsy (CNB) in 16 patients. <b><i>Results:</i></b> The upgrade rate into ductal carcinoma in situ/invasive cancer was the highest in case of imaging/histology discordance (40%). If the number of foci in the biopsy specimen was ≥3, the upgrade rate in the consecutive surgical specimens was increased (<i>p</i> = 0.01). The association of classical LN with histological microcalcification correlated with shortened disease-free survival (<i>p</i> &#x3c; 0.01), whereas other factors showed no impact on follow-up. <b><i>Conclusions:</i></b> Surveillance or subsequent VAB after CNB of LN is sufficient in most cases. Careful consideration of individual radiological and histological factors is required to identify patients with a high risk of upgrade into malignancy. In those cases, surgical excision is indicated.

Is Surgical Excision Necessary for the Management of Atypical Lobular Hyperplasia and Lobular Carcinoma In Situ Diagnosed on Core Needle Biopsy?: A Report of 38 Cases and Review of the Literature

2008 ◽  
Vol 132 (6) ◽  
pp. 979-983 ◽  
Author(s):  
Joan Cangiarella ◽  
Amber Guth ◽  
Deborah Axelrod ◽  
Farbod Darvishian ◽  
Baljit Singh ◽  
...  
Keyword(s):  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Surgical Excision ◽  
Lobular Neoplasia ◽  
Lobular Carcinoma In Situ ◽  
Radiologic Findings ◽  
Atypical Lobular Hyperplasia

Abstract Context.—Both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) have traditionally been considered to be risk factors for the development of invasive carcinoma and are followed by close observation. Recent studies have suggested that these lesions may represent true precursors with progression to invasive carcinoma. Due to the debate over the significance of these lesions and the small number of cases reported in the literature, the treatment for lobular neoplasia diagnosed by percutaneous core biopsy (PCB) remains controversial. Objective.—To review our experience with pure LCIS or ALH diagnosed by PCB and correlate the radiologic findings and surgical excision diagnoses to develop management guidelines for lobular neoplasia diagnosed by PCB. Design.—We searched the pathology database for patients who underwent PCB with a diagnosis of either pure LCIS or ALH and had subsequent surgical excision. We compared the core diagnoses with the surgical excision diagnoses and the radiologic findings. Results.—Thirty-eight PCBs with a diagnosis of ALH (18 cases) or LCIS (20 cases) were identified. Carcinoma was present at excision in 1 (6%) of the ALH cases and in 2 (10%) of the LCIS cases. In summary, 8% (3/38) of PCBs diagnosed as lobular neoplasia (ALH or LCIS) were upgraded to carcinoma (invasive carcinoma or ductal carcinoma in situ) at excision. Conclusions.—Surgical excision is indicated for all PCBs diagnosed as ALH or LCIS, as a significant percentage will show carcinoma at excision.

Lobular Neoplasia of the Breast: An Update

2009 ◽  
Vol 133 (7) ◽  
pp. 1116-1120 ◽  
Author(s):  
Alejandro Contreras ◽  
Husain Sattar
Keyword(s):  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Lobular Neoplasia ◽  
Therapeutic Interventions ◽  
High Grade ◽  
Lobular Carcinoma In Situ ◽  
Molecular Studies ◽  
Pleomorphic Lobular Carcinoma

Abstract Context.—Lobular neoplasias (LNs) of the breast include atypical lobular neoplasia and lobular carcinoma in situ. Recent evidence suggests that LN is not only a risk factor for invasive lobular carcinoma, but is also a nonobligate precursor. Pleomorphic lobular carcinoma in situ (PLCIS) is a subtype of LN that has high-grade nuclei and other features that may mimic high-grade ductal carcinoma in situ. The management and follow-up of patients diagnosed with LN on core biopsy is a current issue of debate. However, recent genomic and molecular studies have identified candidate genes that may be important in understanding the pathogenesis of atypical lobular neoplasia and lobular carcinoma in situ, and thus may lead to other therapeutic interventions. Objective.—To review the literature on LN of the breast and discuss current issues in the diagnosis and management of this entity, with particular attention to the relatively newly recognized lesion PLCIS. Because the management of PLCIS varies from the other LN lesions, the recognition of PLCIS by the pathologist is necessary. Current issues in the molecular pathogenesis of LN are also presented. Data Sources.—Extensive review of the literature. Hematoxylin-eosin–stained and immunohistochemical-stained tissue from the author's personal collection. Conclusions.—Although morphology and immunohistochemical stains, such as E-cadherin, are important in the diagnosis and understanding of LN, genomic and molecular studies may guide the way these lesions are handled in the future. Recognizing PLCIS is important both for patient management and for our future understanding of LN pathogenesis.

Lobular neoplasia on core biopsy: Is excision always indicated?

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 75-75
Author(s):  
C. A. Makarewich ◽  
K. M. Rosenkranz
Keyword(s):  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Incidental Finding ◽  
Lobular Carcinoma ◽  
Excisional Biopsy ◽  
Invasive Disease ◽  
Lobular Neoplasia ◽  
Occult Malignancy

75 Background: Lobular neoplasia (LN) is a continuum of rare, noninvasive lesions of the breast including lobular carcinoma in situ and atypical lobular hyperplasia. Current management is controversial and often includes excisional biopsy in women diagnosed with LN on percutaneous core biopsy (PCB) to exclude an occult malignancy. This strategy is based on retrospective data in women undergoing selective excisions. We performed routine excision of all lesions diagnosed as LN in our institution in order to ascertain a more accurate assessment of pathologic upgrade. Methods: Retrospective review of all prospectively collected cases of LN treated in a single institution from 2007-2010. Excisional biopsies were performed in all cases of LN excepting one (patient declined). Histologic findings of excisional biopsies were reviewed to assess the rate of pathologic upgrade. Results: Of the 2,289 PCBs performed during the study period, LN was found in 23 cases (1.0%). Twenty two (0.96%) cases proceeded to excisional biopsy. On final pathology, malignancy was found in 4 patients (18%). Two of 22 (9%) women were upgraded to ductal carcinoma in situ (DCIS) (both intermediate grade with foci of <1mm and 4mm) and 2/22 (9%) women were diagnosed with invasive lobular carcinoma. Conclusions: While 18% of women in our series had upgraded pathology at the time of excisional biopsy, we support selective rather than routine excisional biopsy. One of the invasive diagnoses was an incidental finding unrelated to the microcalcifications for which biopsy was initially performed. In the second case of invasive disease, the upgraded lesion was a mass identified on MRI performed for surgical planning in a woman already diagnosed with breast cancer. In both cases of DCIS, the area of malignancy was small (<1mm and 4mm) and of uncertain clinical significance. Based on these findings, we do not recommend routine excision of all LN identified on PCB. Cases in which the lesion is associated with a radiographic mass and/or is identified in a breast with a synchronous malignancy do warrant excisional biopsy. Patients without these high risk features can be counseled on the risks of malignancy and given the option of observation with close follow up.

scholarly journals Surgical Excision of Benign Papillomas Diagnosed with Core Biopsy: A Community Hospital Approach

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Eka Rozentsvayg ◽  
Kristen Carver ◽  
Sunita Borkar ◽  
Melvy Mathew ◽  
Sean Enis ◽  
...  
Keyword(s):  
High Risk ◽  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Surgical Excision ◽  
Surgical Pathology ◽  
Ductal Hyperplasia ◽  
Benign Papilloma

Our goal was to assess the value of surgical excision of benign papillomas of the breast diagnosed on percutaneous core biopsy by determining the frequency of upgrade to malignancies and high risk lesions on a final surgical pathology. We reviewed 67 patients who had biopsies yielding benign papilloma and underwent subsequent surgical excision. Surgical pathology of the excised lesions was compared with initial core biopsy pathology results. 54 patients had concordant benign core and excisional pathology. Cancer (ductal carcinoma in situ and invasive ductal carcinoma) was diagnosed in five (7%) patients. Surgery revealed high-risk lesions in 8 (12%) patients, including atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ. Cancer and high risk lesions accounted for 13 (19%) upstaging events from benign papilloma diagnosis. Our data suggests that surgical excision is warranted with core pathology of benign papilloma.

scholarly journals Ductal Carcinoma In Situ of the Breast: Should Breast Irradiation Be Routinely Added to Surgical Excision?

2016 ◽  
Vol 12 (4) ◽  
pp. 309-311 ◽  
Author(s):  
William C. Wood
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Treatment Options ◽  
Genomic Analysis ◽  
Surgical Excision ◽  
Lesion Size ◽  
Medical Community ◽  
New Diagnosis

Confusion exists among women with a new diagnosis of ductal carcinoma in situ and their physicians regarding choice of treatment. The press has accused the medical community of overtreatment and found many physicians eager to support or deny the charge. Improvements in treatment delivery have been matched with better definitions of risk on the basis of biology as defined by genomic analysis rather than only lesion size, margins, receptor status, and patient age. Understanding both the risk of a specific ductal carcinoma in situ progressing to invasive breast cancer and the risks of the treatment options allows tailored recommendations.

scholarly journals UK national survey of management of breast lobular carcinoma in situ

2015 ◽  
Vol 97 (8) ◽  
pp. 574-577 ◽  
Author(s):  
R Chester ◽  
O Bokinni ◽  
I Ahmed ◽  
A Kasem
Keyword(s):  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Surgery ◽  
Lobular Carcinoma ◽  
Surgical Excision ◽  
National Standard ◽  
Excision Biopsy ◽  
Lobular Carcinoma In Situ

Introduction There is no national standard treatment for patients with breast lobular carcinoma in situ (LCIS). Association of Breast Surgery guidelines for the management of breast cancer suggest that lesions containing LCIS should be excised for definitive diagnosis and recommend close surveillance after excision biopsy. The aim of this study was to form a picture of the current management of LCIS by UK breast surgeons. Methods A questionnaire about the management of LCIS was sent to 490 UK breast surgeons. Results Of 490 questionnaires sent out, 173 (35%) were returned. When LCIS is present in a core biopsy, 61% of breast surgeons perform surgical excision, 22% would not excise but would continue follow-up and the remainder perform neither or set no clear management plan. Over half (54%) follow patients up with five years of annual mammography. If classic LCIS were found at the margins of wide local excision, 92% would not re-excise. Conversely, if pleomorphic LCIS were found, 71% would achieve clear margins. Respondents were split evenly regarding management of classic LCIS with a family history as 54% would not alter management whereas 43% would treat the disease more aggressively. Conclusions Our survey has shown that in cases where LCIS is found at core biopsy, most surgeons follow Association of Breast Surgery guidance, obtaining further histological samples to exclude pleomorphic LCIS, ductal carcinoma in situ or invasive cancer, whereas others opt for annual surveillance and some discharge the patient. This study highlighted the huge variability in LCIS management, and the need for randomised controlled trials and input into national audits such as the Sloane Project to establish evidence-based national standard guidelines.

Lobular Neoplasia: Morphology and Management

2014 ◽  
Vol 138 (10) ◽  
pp. 1344-1349 ◽  
Author(s):  
Julie Jorns ◽  
Michael S. Sabel ◽  
Judy C. Pang
Keyword(s):  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Treatment Strategies ◽  
Lobular Neoplasia ◽  
Lobular Carcinoma In Situ ◽  
National Guidelines ◽  
Diagnostic Challenge ◽  
Pleomorphic Lobular Carcinoma

Context.—Lobular neoplasia encompasses a spectrum of disease, including atypical lobular hyperplasia and lobular carcinoma in situ. Although classic forms of lobular neoplasia are predominantly heralded as a risk marker, the pleomorphic form of lobular carcinoma in situ is generally regarded as a more aggressive subtype and a possible cancer precursor, and thus is treated in a manner more similar to ductal carcinoma in situ than classic forms of lobular neoplasia. Objective.—To focus on the morphologic spectrum of lobular neoplasia as highlighted by 3 cases and current management recommendations. Areas of diagnostic challenge and controversy are addressed. Data Sources.—A review of the pertinent published literature and current national guidelines was conducted. Conclusions.—Correct classification of classic lobular neoplasia and pleomorphic lobular carcinoma in situ is critical because of differences in clinical management, with current treatment strategies focused on risk reduction for patients with classic lobular neoplasia and eradication of the lesion for those with pleomorphic lobular carcinoma in situ.

Low diffusion level within a fibroadenoma as the sole sign of ductal carcinoma in situ: A case report

2021 ◽  
pp. 1-4
Author(s):  
Corrado Tagliati ◽  
Giuseppe Lanni ◽  
Federico Cerimele ◽  
Antonietta Di Martino ◽  
Valentina Calamita ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Small Region ◽  
Apparent Diffusion Coefficient Value ◽  
Apparent Diffusion

We present a case of ductal carcinoma in situ within a fibroadenoma. Breast cancer arising within fibroadenoma incidence ranges from 0.125% to 0.02%, and ductal carcinoma in situ is not the most frequent malignancy that can be found within a fibroadenoma. Dynamic contrast-enhanced magnetic resonance imaging showed an oval mass with circumscribed margins and dark internal septations, suspicious for fibroadenoma. According to European Society of Breast Radiology diffusion-weighted imaging consensus, mean apparent diffusion coefficient value obtained by drawing a small region of interest on the lesion apparent diffusion coefficient map showed a low diffusion level. Therefore, ductal carcinoma in situ within a fibroadenoma was diagnosed at final pathology after surgical excision.

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