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 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.

scholarly journals Imaging-Histological Discordance after Sonographically Guided Percutaneous Breast Core Biopsy

Breast Care ◽  
2014 ◽  
Vol 10 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Aykut Soyder ◽  
Füsun Taşkın ◽  
Serdar Ozbas
Keyword(s):  
Core Biopsy ◽  
Breast Biopsy ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Breast Lesions ◽  
Core Needle ◽  
Ductal Carcinomas ◽  
Histological Results

Background: The objectives of this study were to determine the frequency of imaging-histological discordance and to compare the frequency of carcinoma between discordant lesions at ultrasound (US)-guided core needle biopsy. Materials and Methods: From November 2009 to June 2012, we performed US-guided 14-gauge core needle biopsies on 989 breast lesions in 961 women. We reviewed 58 (5.8%) cases that had imaging-histological discordance after percutaneous breast biopsy and underwent subsequent excisional biopsy. The clinical, radiological, and histological findings were reviewed for those 58 cases. Results: Among the 58 cases, subsequent excisions revealed 16 (27.5%) malignancies, which were categorized as 9 (15.5%) invasive ductal carcinomas, 4 (6.9%) malignant phyllodes tumors, and 3 (5.1%) ductal carcinomas in situ. Conclusion: The malignancy rate of 27.5% suggests that surgical excision should be performed in those cases presenting with imaging-histological discordance after US-guided core biopsy. Careful correlation of clinical, radiological, and histological results as well as appropriate follow-up are essential.

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 Needed for Pure FEA Diagnosed on a Core Biopsy?

2020 ◽  
Vol 86 (9) ◽  
pp. 1088-1090
Author(s):  
Jennifer L. Miller-Ocuin ◽  
Brett B. Fowler ◽  
Daniel L. Coldren ◽  
Akiko Chiba ◽  
Edward A. Levine ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Core Biopsy ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Invasive Cancer ◽  
Architectural Distortion ◽  
Core Needle ◽  
Ductal Hyperplasia

Background The management of flat epithelial atypia (FEA) on core needle biopsy remains controversial. The upstaging rates after surgical excision are variable. In this study, we seek to determine the upstaging rate of FEA at our institution. Methods Patients with a diagnosis of FEA were identified from the institution’s pathology database from 2009 to 2018. Patients were included in the study if FEA alone, without atypia or cancer, was identified on core needle biopsy. Patient demographics, imaging, management, and pathology characteristics were obtained. Statistical analysis performed using IBM SPSS 26.0 (Armonk, NY, USA). Results FEA was diagnosed on core needle biopsy in 235 patients from 2009 to December 2018. Forty-eight patients met the inclusion criteria. The majority of patients presented with calcifications on mammogram (n = 21, 64%) with the remainder as masses (n = 6, 18%) or architectural distortion (n = 6, 18%). Of those, 15 (31%) patients declined surgical excision, of which none developed cancer over a mean follow-up of 4.4 years. Of the 33 (69%) patients undergoing excisional biopsy, 17 (52%) confirmed FEA, 11 (33%) had benign findings, and 3 (9%) demonstrated atypical ductal hyperplasia on final pathology. One (3%) case revealed ductal carcinoma in situ (DCIS) and 1 (3%) was upgraded to invasive cancer for an overall upstaging rate of 4% (2/48). After a mean follow-up of 3.4 years, none of the excisional biopsy patients developed invasive breast cancer. Adjuvant therapy was used in the cases of DCIS and invasive cancer; however, chemoprevention with raloxifene or tamoxifen was not chosen by any of the remaining patients. Conclusion In our cohort, expectant management of FEA alone appears to be a safe option as our upstaging rate to DCIS or invasive cancer for FEA diagnosed on core biopsy was only 4%. Our study suggests that close follow-up is a safe and feasible option for pure FEA without a radiographic discordance found on core biopsy.

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