Surgical outcome of lobular neoplasia diagnosed in core biopsy: Prospective study of 316 cases.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 4-4 ◽  
Author(s):  
Barbara Susnik ◽  
Deborah Day ◽  
Janet Krueger ◽  
Ellen Abeln ◽  
Tara Bowman ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
Prospective Study ◽  
Core Biopsy ◽  
Lobular Carcinoma ◽  
Positive Family History ◽  
Surgical Excision ◽  
Lobular Neoplasia ◽  
Group I ◽  
Atypical Lobular Hyperplasia ◽  
Mass Lesions

4 Background: Recommendations for management of lobular neoplasia (LN) including lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) diagnosed in core biopsy specimens (CB) are controversial. The aim of our prospective study is to identify subset of patients with LN diagnosed in CB who do not require subsequent surgical excision (SE). Methods: All patients with a diagnosis of ALH or LCIS on CB were referred for SE. Cases with coexistent DCIS or invasive breast carcinoma were excluded. Cases with coexistent ductal atypia including FEA or ADH (LN-DA) and LCIS variants including pleomorphic or necrotic LCIS (LN-V) were separated from classic LN (LN-C). Dedicated breast pathologists and radiologists reviewed all cases with careful imaging/pathology (IP) correlation. Results: From June 2008 to December 2013, 13,772 percutaneous breast CB procedures were performed. A total of 370 patients with LN diagnosed on CB were referred to SE. 302 (82%) patients with 316 lesions underwent SE within 2 months after initial diagnosis. Average age was 55.3, 27% had positive family history and 4% had previous breast carcinoma. After patients with synchronous ipsilateral CB showing cancer were excluded (20 patients) from upgrade analysis, the diagnostic groups included 228 LN-C, 15 LN-V and 53 LN-DA. In the LN-C group I/P discordance represented 6/228 cases (2.6%). Upgrade to carcinoma of LN-C varied between discordant (6/6) and concordant cases (8/222=3.6%). In comparison, upgrades were seen in 26.7% LN-V (4/15), and 28.3% LN-DA (15/53). For concordant LN-C, the imaging target was calcifications in 176/222 cases (81%); 7 were associated with upgrade (3.9%). Upgrades were rare for MRI targeted lesions (0/14) and mass lesions (1/32). Overall, upgrades were similar for ALH and LCIS (3.4% vs. 4.5 %). Conclusions: While LN with nonclassic morphology or with associated ductal atypia requires SE, this can be avoided in classic LN diagnosed on CB targeting calcifications when careful imaging/pathology correlation is applied; the likelihood of unsuspected cancer diagnosis is minimal and limited to coincidental cases. Until larger numbers are studied, excising classic LN diagnosed as masses or MRI detected lesions may be prudent.

Is Excisional Biopsy and Chemoprevention Warranted in Patients with Atypical Lobular Hyperplasia on Core Biopsy?

2015 ◽  
Vol 81 (9) ◽  
pp. 876-878 ◽  
Author(s):  
Shelby Allen ◽  
Edward A. Levine ◽  
Nadja Lesko ◽  
Marissa Howard-Mcnatt
Keyword(s):  
Breast Cancer ◽  
Core Biopsy ◽  
Lobular Carcinoma ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Patient Characteristics ◽  
Current Treatment ◽  
Final Pathology ◽  
Atypical Lobular Hyperplasia

The management of atypical lobular hyperplasia (ALH) on core biopsy remains controversial. The upstaging rates after surgical excision vary. We reviewed our upgrade rates and use of chemoprevention for ALH. Patients were identified through our pathology database for ALH from 2006 to 2013. Patients were included in the study that had a diagnosis only of ALH on core needle biopsy. Tumor and patient characteristics and final pathology were analyzed. ALH was identified in 56 patients since 2006. Sixteen patients met the inclusion criteria. All the patients underwent surgical excision. Final pathology of the excised specimens confirmed ALH in 62 per cent (n = 11). Two cases contained lobular carcinoma in situ. The upgrade rate on excisional biopsy was 18.75 per cent (n = 3) to invasive cancer. Chemopreventative treatment was taken by 44 per cent of the patients. After a mean follow-up of three years, none of the patients who received chemoprevention developed breast cancer. One patient who refused tamoxifen developed breast cancer. This is one of the few studies to examine the current treatment of ALH. We noted a significant upstaging rate after excision. We recommend women to undergo surgical excision. Patients should also consider chemoprevention to reduce their risk for developing breast cancer.

Lobular Neoplasia: Is Surgical Excision Warranted?

2008 ◽  
Vol 74 (2) ◽  
pp. 172-177 ◽  
Author(s):  
Vance Y. Sohn ◽  
Zachary M. Arthurs ◽  
Flora S. Kim ◽  
Tommy A. Brown
Keyword(s):  
Breast Cancer ◽  
Lobular Carcinoma ◽  
Surgical Excision ◽  
Clinical History ◽  
Lobular Neoplasia ◽  
Surgical Biopsy ◽  
Atypical Lobular Hyperplasia ◽  
Open Surgical Biopsy

The treatment of breast cancer associated with lobular neoplasia detected on core needle biopsy (CNB) remains controversial. The purpose of this study was to review the prevalence of lobular neoplasia in CNB specimens and to correlate CNB pathology to final surgical pathology. Patients with lobular neoplasia were included for analysis in this retrospective review. Patients with concomitant malignant or atypical lesions were excluded. Method of initial diagnosis, clinical history, pathology results, and follow-up data were then analyzed. From January 1994 to December 2005, 5257 CNBs were performed at our tertiary level medical facility. Of patients with lobular neoplasia, 42 of 50 (84%) patients had atypical lobular hyperplasia, whereas 8 (16%) patients were diagnosed with lobular carcinoma in situ on CNB specimens. There were no associated malignancies in 21 patients who underwent immediate surgical excision. Of those patients who were serially followed, four developed malignancies at an average of 73 months after the sentinel diagnosis. Three of the four (75%) malignancies occurred in the ipsilateral breast. Patients with a diagnosis of lobular neoplasia by CNB should not routinely undergo an open surgical biopsy. Lobular neoplasia should only be considered a risk marker for future invasive breast cancer.

scholarly journals Triaging Atypical Lobular Hyperplasia and Lobular Carcinoma In Situ on Percutaneous Core Biopsy to Surgery or Observation: Assiduous Radiologic-Pathologic Correlation Works, Quantitating Extent of Disease Does Not

2018 ◽  
Vol 143 (5) ◽  
pp. 621-627 ◽  
Author(s):  
Anna I. Holbrook ◽  
Krisztina Hanley ◽  
Caprichia Jeffers ◽  
Jian Kang ◽  
Michael A. Cohen
Keyword(s):  
Core Biopsy ◽  
Lobular Carcinoma ◽  
Rank Correlation ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Core Needle ◽  
Pathologic Correlation ◽  
Atypical Lobular Hyperplasia ◽  
Kendall Rank Correlation ◽  
Imaging Observation

Context.— The management of lobular neoplasia (LN) found on core biopsy is controversial and ranges from obligatory surgical excision to clinical/imaging observation. Objective.— To determine if in cases of core needle biopsy yielding LN, quantification of normal and diseased terminal ductal lobular units (TDLUs) can predict which cases require surgical excision and which can be safely followed. A secondary goal is to assess whether the concordance or discordance of core biopsy results, determined by rigorous radiologic-pathologic correlation, can predict for upgrade to malignancy at excision. Design.— In this retrospective study, 79 specimens from 78 women who underwent image-guided core needle biopsies between 2005 and 2012 yielding LN were evaluated for total number of TDLUs and total number and percentage of TDLUs involved by LN. Additionally, radiologic-pathologic correlation was performed to assess concordance or discordance. All were correlated with the results of surgical excisional biopsy or imaging/clinical follow-up. Results.— There were 5 upgrades to malignancy. There was no association between upgrade to malignancy and any of the 3 TDLU variables evaluated, including total TDLUs in the specimen (P = .42), total abnormal TDLUs (P = .56), and percent of TDLUs that are abnormal (P = .07). Kendall rank correlation demonstrated a correlation between discordance and upgrade to cancer at surgery that was statistically significant (τb = −0.394, P < .001). Conclusions.— Quantifying total TDLU and those involved by LN on core biopsy will not aid in triaging patients to surgery or observation. Assiduous radiologic-pathologic correlation to determine lesion concordance/discordance can predict those patients who would benefit from surgical excision.

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.

Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy

Cancer ◽  
2012 ◽  
Vol 119 (5) ◽  
pp. 1073-1079 ◽  
Author(s):  
Melissa P. Murray ◽  
Chad Luedtke ◽  
Laura Liberman ◽  
Tatjana Nehhozina ◽  
Muzaffar Akram ◽  
...  
Keyword(s):  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Lobular Carcinoma ◽  
Lobular Carcinoma In Situ ◽  
Atypical Lobular Hyperplasia

Lobular neoplasia: does 11 Gauge core biopsy allow to avoid surgical excision? A study of 58 consecutive cases

2006 ◽  
Vol 4 (2) ◽  
pp. 82-83
Author(s):  
M.P. Chauvet ◽  
Ceugnart ◽  
M.C. Baranzelli ◽  
S. Giard ◽  
R. Uzan ◽  
...  
Keyword(s):  
Core Biopsy ◽  
Surgical Excision ◽  
Lobular Neoplasia

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 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.

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