Lobular neoplasia detected in MRI-guided core biopsy carries a high risk for upgrade: a study of 63 cases from four different institutions

Abstract

There are certain criteria to recommend surgical excision for lobular neoplasia diagnosed in mammographically detected core biopsy. The aims of this study are to explore the rate of upgrade of lobular neoplasia detected in magnetic resonance imaging (MRI)-guided biopsy and to investigate the clinicopathological and radiological features that could predict upgrade. We reviewed 1655 MRI-guided core biopsies yielding 63 (4%) cases of lobular neoplasia. Key clinical features were recorded. MRI findings including mass vs non-mass enhancement and the reason for biopsy were also recorded. An upgrade was defined as the presence of invasive carcinoma or ductal carcinoma in situ in subsequent surgical excision. The overall rate of lobular neoplasia in MRI-guided core biopsy ranged from 2 to 7%, with an average of 4%. A total of 15 (24%) cases had an upgrade, including 5 cases of invasive carcinoma and 10 cases of ductal carcinoma in situ. Pure lobular neoplasia was identified in 34 cases, 11 (32%) of which had upgrade. In this group, an ipsilateral concurrent or past history of breast cancer was found to be associated with a higher risk of upgrade (6/11, 55%) than contralateral breast cancer (1 of 12, 8%; P = 0.03). To our knowledge, this is the largest series of lobular neoplasia diagnosed in MRI-guided core biopsy. The incidence of lobular neoplasia is relatively low. Lobular neoplasia detected in MRI-guided biopsy carries a high risk for upgrade warranting surgical excision. However, more cases from different types of institutions are needed to verify our results.

Screening vs staging magnetic resonance imaging‐guided core needle breast biopsies: Does MRI indication impact upgrade rate?

“…There is a paucity of data, however, as to the rate of upgrade and need for excision of ADH and lobular neoplasia when the diagnosis is made following abnormal MRI. Studies have shown that high‐risk lesions detected via MRI, will be upgraded to malignancy upon excision, at a variable rate, ranging from 15%‐50% for ADH and 0%‐33% for lobular neoplasia (LN) …”

“…Review of the literature provides minimal consensus regarding the risk of upgrade for MRI‐detected atypical lesions, with estimates ranging from 15%‐50% for ADH and 0%‐33% for LN . The overall upgrade rate of 24.3%, observed in the present study, is consistent with cited literature for MRI‐detected lesions, as well as for mammographically identified atypical lesions.…”

“…The present study identified an upgrade rate of 29.2% for LN, with no distinction observed between LCIS and ALH. The reported upgrade rate of MRI‐identified LN varies, with rates ranging from 0% to 33% . Susnik et al aimed to identify the subset of cases of LN which conferred the greatest risk and found that upgrade was present in 3.5% (8/228) of classic LN, 26.7% (4/15) of LCIS variants, and 28.3% (15/53) of cases with coexistent ductal atypia.…”

“…Studies have shown that high-risk lesions detected via MRI, will be upgraded to malignancy upon excision, at a variable rate, ranging from 15%-50% for ADH 5,7-9 and 0%-33% for lobular neoplasia (LN). 5,7,[10][11][12] It is not known whether the upgrade rate of high-risk lesions varies among women with atypia found on screening MRI vs women with Abstract Adjunct magnetic resonance imaging (MRI) for both screening high-risk patients and staging for patients with newly diagnosed breast cancer leads to an increased number of biopsies and increased detection of atypical lesions. We assessed whether the malignancy upgrade frequency for high-risk atypia identified via MRI-guided biopsies varied based on indication: high-risk screening vs staging for malignancy.Among 399 MRI-guided biopsies, 46 (11.5%) high-risk lesions (ADH, ALH, and LCIS) were identified.…”

Pathologic Findings of Breast Lesions Detected on Magnetic Resonance Imaging

“…However, in certain instances these lesions represent a dominant finding, as in lobular carcinoma in situ. 26,27 Normal breast tissue can show significant enhancement depending on the phase of the menstrual cycle, further complicating image interpretation. 1,24 Twenty-one of our biopsies showed normal breast tissue, of which 11 patients had follow-up imaging studies documenting resolution of the initial lesion, 4 patients had repeat biopsies showing either benign breast tissue or fibrocystic changes, and 1 patient underwent total mastectomy with concordant results.…”