Lobular Neoplasia and Atypical Ductal Hyperplasia on Core Biopsy: Current Surgical Management Recommendations

Racz, Jennifer M.; Carter, Jodi M.; Degnim, Amy C.

doi:10.1245/s10434-017-5978-0

Cited by 29 publications

(31 citation statements)

References 103 publications

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“…This is not in-keeping with published reports that suggest the risk of upgrade for LCIS 2-4 times higher than that of ALH. 12,27,29 This study's overall LIN upgrade rate of 13.64% is significant, is in-keeping with the results of a recent large meta-analysis, 30 and adequately justifies the practice of routinely excising such lesions. Vacuum-assisted excision (VAE) is a minimally invasive alternative to surgical excision of benign breast lesions.…”

Section: Discussionsupporting

confidence: 82%

“…In this study, all nine of the upgraded lesions were initially reported as ALH on CNB, while none of the LCIS lesions were upgraded on final excision. This is not in‐keeping with published reports that suggest the risk of upgrade for LCIS 2‐4 times higher than that of ALH 12,27,29 . This study's overall LIN upgrade rate of 13.64% is significant, is in‐keeping with the results of a recent large meta‐analysis, 30 and adequately justifies the practice of routinely excising such lesions.…”

Section: Discussioncontrasting

confidence: 51%

“…Recent large reviews examining this issue have shown rates of 13%-27%, therefore advocating for diagnostic excision. 8,13,14,27 Other studies report upgrade rates from 0%-4%, and oppose routine excision. 9,16,17,28 In this study, all nine of the upgraded lesions were initially reported as ALH on CNB, while none of the LCIS lesions were upgraded on final excision.…”

Section: Discussionmentioning

confidence: 99%

“…There is a large degree of heterogeneity in the published literature with regard to upgrade rates for LIN. Recent large reviews examining this issue have shown rates of 13%‐27%, therefore advocating for diagnostic excision 8,13,14,27 . Other studies report upgrade rates from 0%‐4%, and oppose routine excision 9,16,17,28 …”

Section: Discussionmentioning

confidence: 99%

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Lobular intraepithelial neoplasia: Outcomes and optimal management

et al. 2020

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Introduction: Lobular neoplasia is a term encompassing both atypical lobular hyperplasia and lobular carcinoma in situ. These pathological findings are of uncertain malignant potential and predispose to a higher lifetime risk of breast cancer. Debate surrounds the management of such lesions, with the rationale for diagnostic excision based on the possibility of upgrading to malignancy. In this study, we report the upgrade rate of these lesions and risk of subsequent development of breast cancer. Methods: This is a retrospective review of a prospectively maintained data base of all biopsies of breast screening-detected abnormalities in a single Irish breast-screening unit. We included all patients with lobular neoplasia on core needle biopsy who underwent diagnostic excision from 2005 to 2012. We excluded those who had concurrent high-risk lesions on biopsy. End points included upgrade rate and subsequent diagnosis of malignancy on follow-up. Results: During the study period, 66 patients met criteria for inclusion, with a mean age of 53.74 years. Upgrade rate following excision was 13.64% (n = 9/66). Of those not upgraded, 7.02% (n = 4/57) were subsequently diagnosed with malignancy. Median time to diagnosis was 59.61 months (range = 10.5-124.4). Conclusion: There is a significant rate of upgrade following diagnostic excision of lobular neoplasia, supporting the practice of diagnostic excision. There is an increased lifetime risk of breast cancer for women with a diagnosis of lobular neoplasia, with many of these cancers occurring outside the standard five-year monitoring period, suggesting a potential benefit in extending surveillance.

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Section: Discussionsupporting

confidence: 82%

Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Lobular intraepithelial neoplasia: Outcomes and optimal management

et al. 2020

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“…Excision is unnecessary. 35 Patients found to have atypical hyperplasia on breast biopsy should receive counseling about risk-reducing medications. Selective estrogen receptor modulators such as tamoxifen…”

Section: ■ Atypical Hyperplasia: Increased Riskmentioning

confidence: 99%