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.

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.

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.

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