Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In-situ in Patients with Lobular Neoplasia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 020)

Context Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain. Objective To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management. Design Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed. Results Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001). Conclusions No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively.

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Pathologic Review of Atypical Hyperplasia Identified by Image-Guided Breast Needle Core Biopsy

Archives of Pathology & Laboratory Medicine ◽

10.5858/2003-127-49-proahi ◽

2003 ◽

Vol 127 (1) ◽

pp. 49-54 ◽

Cited By ~ 4

Author(s):

I-Tien Yeh ◽

Diana Dimitrov ◽

Pamela Otto ◽

Alexander R. Miller ◽

Morton S. Kahlenberg ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Core Biopsy ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Needle Core Biopsy ◽

Atypical Lobular Hyperplasia ◽

Ductal Hyperplasia

Abstract Context.—Management of breast needle core biopsies diagnosed as atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ is controversial. Current recommendations involve excisional biopsy to rule out ductal carcinoma in situ and/or invasive carcinoma, which have been reported in more than 50% of cases in some series. Objective.—To determine how frequently these diagnoses made on needle core biopsy are ultimately found to represent in situ or invasive carcinoma based on excisional biopsy specimens, in order to identify predictive factors. Design.—One thousand eight hundred thirty-six image-guided needle core biopsies were performed between January 1, 1995 and May 1, 2001. Fifty-four (2.9%) patients diagnosed with atypical ductal hyperplasia (n = 36), atypical lobular hyperplasia (n = 12), atypical ductal hyperplasia + atypical lobular hyperplasia (n = 3), or lobular carcinoma in situ (n = 3) subsequently underwent breast excisions. Pathologic features were reviewed in each of the needle core biopsies using Page's criteria and were then correlated with excision specimens. Setting.—University medical center. Results.—Review of the needle core biopsy cases with either ductal carcinoma in situ or invasive carcinoma + ductal carcinoma in situ on final excision showed that nucleoli were evident in most of the needle core cases, with foci of nuclear pleomorphism and individual cell necrosis or apoptosis. Conclusion.—A more precise diagnosis can be made by using strict criteria for atypical ductal hyperplasia versus ductal carcinoma in situ on needle core biopsy. Cytologic atypia, even if in a small area, particularly when there is apoptosis/individual cell necrosis, correlates with the finding of a more serious lesion on excision.

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The Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In Situ in Patients with Intraductal Papilloma without Atypia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 034)

Annals of Surgical Oncology ◽

10.1245/s10434-020-09215-w ◽

2020 ◽

Cited By ~ 1

Author(s):

Faina Nakhlis ◽

Gabrielle M. Baker ◽

Melissa Pilewskie ◽

Rebecca Gelman ◽

Katherina Z. Calvillo ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Core Biopsy ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Ductal Carcinoma ◽

Intraductal Papilloma

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Excisional Biopsy Should Be Performed if Lobular Carcinoma In Situ Is Seen on Needle Core Biopsy

Archives of Pathology & Laboratory Medicine ◽

10.5858/2002-126-0697-ebsbpi ◽

2002 ◽

Vol 126 (6) ◽

pp. 697-701 ◽

Cited By ~ 8

Author(s):

Sandra J. Shin ◽

Paul Peter Rosen

Keyword(s):

Ductal Carcinoma In Situ ◽

Core Biopsy ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Ductal Carcinoma ◽

Lobular Carcinoma ◽

Excisional Biopsy ◽

Primary Diagnosis ◽

Needle Core Biopsy

Abstract Context.—Percutaneous image-guided core biopsy is increasingly becoming the method of choice to evaluate impalpable breast lesions presenting with mammographically detected calcifications or as a mammographically detected mass. Infrequently, a diagnosis of a primary lobular lesion is rendered by needle core biopsy. Although lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) are not themselves detectable by mammography, they can be associated with calcifications. The management of patients with a primary diagnosis of LCIS or ALH on needle core biopsy is uncertain. Recommendations include excisional biopsy, tamoxifen citrate therapy, mammographic surveillance, or a combination of these approaches. Objective.—The purpose of this study was to report the histologic findings of excisional biopsies performed after ALH or LCIS was found in a needle core biopsy. Design.—Hematoxylin-eosin–stained slides of 20 needle core biopsy specimens from patients with a primary diagnosis of LCIS or ALH were retrieved from the consultation and surgical pathology files of New York Presbyterian Hospital–Weill Medical College of Cornell University. Histologic diagnoses were confirmed in all cases. Results.—Fourteen cases of primary LCIS and 6 cases of ALH found on needle core biopsy were identified. Subsequent excisional biopsy of the 14 LCIS cases revealed the following: LCIS, ductal carcinoma in situ, invasive carcinoma (1 patient; 7%); LCIS, infiltrating lobular carcinoma (1 patient; 7%); LCIS, ductal carcinoma in situ (1 patient; 7%); LCIS (8 patients; 57%); and ALH with or without atypical ductal hyperplasia (3 patients; 21%). Among the 6 patients with ALH on needle core biopsy, 1 had infiltrating lobular carcinoma and LCIS and 2 had LCIS in subsequent excision; other excisions for ALH were benign. Overall, 3 (21%) of 14 patients with a primary diagnosis of LCIS on needle core biopsy had a more significant lesion (ductal carcinoma in situ or invasive carcinoma) in a subsequent excisional biopsy. Conclusions.—Data obtained in this study and in previously published reports lead us to conclude that excisional biopsy may be indicated and should be considered when LCIS is found on needle core biopsy in order to more fully examine the biopsy site for coexistent, clinically inapparent intraductal or invasive carcinoma that may be present in about 25% of these patients. The small number of ALH cases studied produced inconclusive results. We recommend that excisional biopsy be considered if atypical ductal hyperplasia is present with ALH in a needle core biopsy or if the diagnosis of the biopsy specimen is discordant with the mammographic findings.

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