Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Core Breast Biopsy: Use of Careful Radiologic-Pathologic Correlation to Recommend Excision or Observation

Atkins, Kristen A.; Cohen, Michael A.; Nicholson, Brandi T.; Rao, Sandra

doi:10.1148/radiol.13121730

Cited by 45 publications

(7 citation statements)

References 42 publications

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“…While pathologic-radiographic concordance is likely more important than pure BIRADS classification, studies reporting both have consistently reported the lowest upgrade rates. Atkins et al 23 reported no upgrades among 38 concordant lesions, Chaudhary et al 25 reported an upgrade rate of 3% among 87 concordant lesions, and, similar to our study, Murray et al 32 conducted a prospective study of 80 excisions following a core biopsy diagnosis of pure LN and reported 2 upgrades (3%) among 72 concordant cases. In contrast, in the discordant group, the upgrade rate was 3/8 (38%).…”

Section: Discussionsupporting

confidence: 88%

“…Table 4 7,14,19–21,23–31 summarizes the findings of the more contemporary, larger (comprising more than 20 cases) series on this subject and demonstrates that upgrade rates remain highly variable, ranging from 0% to 27%. In our prospective study with strict eligibility criteria and central pathology review, we found an upgrade rate for concordant, BI-RADS 4 or lower, pure LN lesions to be 3% based on the local pathology diagnosis and 1% based on central pathology review.…”

Section: Discussionmentioning

confidence: 96%

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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)

et al. 2015

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Background Lobular neoplasia (LN) represents a spectrum of atypical proliferative lesions, including atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS). The need for excision for LN found on core biopsy (CB) is controversial. We conducted a prospective multi-institutional trial (TBCRC 20) to determine the rate of upgrade to cancer following excision for pure LN on CB. Methods Patients with a CB diagnosis of pure LN were prospectively identified and consented for excision. Cases with discordant imaging and those with additional lesions requiring excision were excluded. Upgrade rates to cancer were quantified based on local and central pathology review. Confidence intervals (CI) and sample size were based on exact binomial calculations. Results 77 of 79 registered patients underwent excision (median age 51 years, range 27–82). 2 (3%, 95%CI 0.3%–9%) cases were upgraded to cancer (1 tubular carcinoma, 1 DCIS) at excision per local pathology. Central pathology review of 76 cases confirmed pure LN in the CB in all but two cases. In one case, the tubular carcinoma identified at excision was also found in the CB specimen, and in the second case, LN was not identified, yielding an upgrade rate of 1 case (1%, 95%CI 0.01%–7%) by central pathology review. Conclusions In this prospective study of 77 patients with pure LN on CB, the upgrade rate was 3% by local pathology and 1% by central pathology review, demonstrating that routine excision is not indicated for patients with pure LN on core biopsy and concordant imaging findings.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 96%

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)

et al. 2015

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“…Studies seek to find parameters that facilitate the management of patients diagnosed with precursor lesions on percutaneous biopsy, informing decisions regarding the choice between surgery and follow-up alone. A multidisciplinary team can offer individualized treatment options for patients with concordant findings in the imaging and histological analyses ( 32 - 34 ) . Precursor lesions are of low grade, with a low risk for disease progression ( 35 ) .…”

Section: Discussionmentioning

confidence: 99%

Suspicious amorphous microcalcifications detected on full-field digital mammography: correlation with histopathology

et al. 2018

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ObjectiveTo evaluate suspicious amorphous calcifications diagnosed on full-field digital mammography (FFDM) and establish correlations with histopathology findings.Materials and MethodsThis was a retrospective study of 78 suspicious amorphous calcifications (all classified as BI-RADS® 4) detected on FFDM. Vacuum-assisted breast biopsy (VABB) was performed. The histopathological classification of VABB core samples was as follows: pB2 (benign); pB3 (uncertain malignant potential); pB4 (suspicion of malignancy); and pB5 (malignant). Treatment was recommended for pB5 lesions. To rule out malignancy, surgical excision was recommended for pB3 and pB4 lesions. Patients not submitted to surgery were followed for at least 6 months.ResultsAmong the 78 amorphous calcifications evaluated, the histopathological analysis indicated that 8 (10.3%) were malignant/suspicious (6 classified as pB5 and 2 classified as pB4) and 36 (46.2%) were benign (classified as pB2). The remaining 34 lesions (43.6%) were classified as pB3: 33.3% were precursor lesions (atypical ductal hyperplasia, lobular neoplasia, or flat epithelial atypia) and 10.3% were high-risk lesions. For the pB3 lesions, the underestimation rate was zero.ConclusionThe diagnosis of precursor lesions (excluding atypical ductal hyperplasia, which can be pB4 depending on the severity and extent of the lesion) should not necessarily be considered indicative of underestimation of malignancy. Suspicious amorphous calcifications correlated more often with precursor lesions than with malignant lesions, at a ratio of 3:1.

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“…Historically, women with high-risk proliferative breast lesions (atypical hyperplasia [ALH], or LCIS) on needle biopsy have been referred for surgical excision due to the possibility of a co-existing, occult carcinoma at the site of the residual imaging abnormality (18–22). While this topic remains controversial, recent reports suggest that not all women with ALH or LCIS on needle biopsy require surgical excision to rule out a higher grade lesion (23–28).…”

Section: Histopathologic Considerationsmentioning

confidence: 99%

Paradigm Shifts in Breast Care Delivery: Impact of Imaging in a Multidisciplinary Environment

Krishnamurthy

Bevers

Kuerer

et al. 2017

American Journal of Roentgenology

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The practice of breast imaging in a collaborative multidisciplinary environment adds significant value to outcomes in women’s healthcare. In this article, we describe multidisciplinary considerations in breast cancer screening and early detection, the impact of imaging and histopathologic findings in the diagnostic evaluation and management of breast abnormalities, and the contribution of imaging to surgical and radiation therapy planning for the breast cancer patient.

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Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Core Breast Biopsy: Use of Careful Radiologic-Pathologic Correlation to Recommend Excision or Observation

Abstract: When careful radiologic-pathologic correlation is performed and concordance is achieved, women with ALH or LCIS at core biopsy can be observed.

Cited by 45 publications

References 42 publications

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)

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)

Suspicious amorphous microcalcifications detected on full-field digital mammography: correlation with histopathology

Paradigm Shifts in Breast Care Delivery: Impact of Imaging in a Multidisciplinary Environment

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