Lobular neoplasia on core‐needle biopsy—Clinical significance

Arpino, Grazia; Allred, D. Craig; Mohsin, Syed K.; Weiss, Heidi L.; Conrow, David; Elledge, Richard M.

doi:10.1002/cncr.20318

Cited by 109 publications

(65 citation statements)

References 39 publications

(30 reference statements)

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“…In addition, pleomorphic LCIS is often associated with mammographic calcifications, and when invasive carcinoma does arise in association with pleomorphic LCIS it does so in its immediate vicinity. 4,20 These findings are more akin to the radiologic and clinical behavior of DCIS and therefore were excluded from our study cases because we always recommend excision of these lesions.…”

Section: Discussionmentioning

confidence: 99%

“…However, the literature documents this rate as ranging anywhere from 0.5% to 8% in breast biopsies, with this discrepancy representing a gradual increase extending up to the present day. [3][4][5][6]10,14,[20][21][22] This variation and the increased incidence noted in recent years is likely correlated with improvements in breast imaging and the subsequent increase in the frequency of CNB, as well as the greater amount of tissue acquired through the larger bore vacuum suction needles.…”

Section: Discussionmentioning

confidence: 99%

“…3,10 The increased risk that LN confers constitutes subsequent invasive carcinoma of both ductal and lobular type in either breast. [3][4][5][6]10,20,23 Classic LCIS is rarely associated with calcifications and does not present as an area of mammographic abnormality. 3,5,10,23 In those cases in which calcifications are identified, they are usually restricted to areas of fibrocystic change adjacent to the LCIS.…”

Section: Discussionmentioning

confidence: 99%

“…This disparity may be correlated in part with the retrospective nature of these studies, in which the purpose of FSE after CNB was not always known. 20,25 For example, a discrepancy between the radiologically and pathologically identified mass lesion/calcifications in a case may have resulted from 1 or both of the following reasons: 1) the mass lesion/calcifications, particularly those prompting the biopsy, may have been inadequately sampled; or 2) the mass lesion/calcifications of interest may have been left unsampled in the histologic block. If LN was observed in the CNB without another lesion mandating excision (ie, the mass lesion/calcifications noted on mammography), then one could mistakenly reason that the upstaging of the excisional biopsy was connected to the presence of LN.…”

Section: Discussionmentioning

confidence: 99%

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Lobular neoplasia on core needle biopsy does not require excision

Nagi

O'Donnell

Tismenetsky

et al. 2008

Cancer

107

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BACKGROUND. Lobular neoplasia (LN), encompassing atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), is often an incidental finding on core needle biopsies (CNBs) performed in instances of radiologic densities and/or calcifications. Because LN is generally considered a risk factor for breast carcinoma, the utility of subsequent excision is controversial. METHODS. The authors' database yielded 98 cases of LCIS and/or ALH. Cases containing LN accompanied by a second lesion mandating excision (eg, radial scar, atypical ductal hyperplasia [ADH]) and those failing to meet strict diagnostic criteria for LN (eg, atypical cells, mitoses, single‐cell necrosis) were excluded. Radiographic calcifications were correlated with their histologic counterparts in terms of size, number, and pattern. RESULTS. Ninety‐one biopsies were performed for calcifications and 7 were performed for mass lesions. The ages of the patients ranged from 35 to 82 years. Fifty‐three patients were followed radiologically without excision, 42 of whom had available clinicoradiologic information. The 45 patients who underwent excision were without disease at follow‐up periods ranging from 1 to 8 years. Of these 45 patients, 42 (93%) had biopsy results demonstrating only LN. The remaining 3 patients had biopsies with the following findings: ADH in 1 biopsy, residual LCIS and a separate minute focus of infiltrating lobular carcinoma (clearly an incidental finding) in the second biopsy, and ductal carcinoma in situ admixed with LCIS in the third biopsy (a retrospective examination performed by 2 blinded breast pathologists revealed foci of atypical cells and mitoses). CONCLUSIONS. Excision of LN is unnecessary provided that: 1) careful radiographic‐pathologic correlation is performed; and 2) strict histologic criteria are adhered to when making the diagnosis. Close radiologic and clinical follow‐up is adequate. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Lobular neoplasia on core needle biopsy does not require excision

Nagi

O'Donnell

Tismenetsky

et al. 2008

Cancer

107

View full text Add to dashboard Cite

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“…The number of cases included in previously published studies (combining atypical lobular hyperplasia and lobular carcinoma in situ) varies from less than 10 up to 92 cases of lobular neoplasia followed by immediate excision. [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] In comparison, our study includes a relatively high number of cases (87 cases of lobular neoplasia followed by immediate excision). Another limitation in our study and others is that it is retrospective and may suffer from selection bias regarding the patients that underwent excision.…”

Section: Discussionmentioning

confidence: 99%

Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary

Hwang

Barke

Mendelson³

et al. 2008

Modern Pathology

104

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Standardized recommendations for the management of lobular neoplasia in core biopsy specimens are not established. The aim of our study was to define morphologic features of lobular neoplasia in core biopsies that predict the finding of ductal carcinoma in situ or invasive carcinoma in the subsequent excisional specimen. We reviewed 333 cases of atypical lobular hyperplasia or lobular carcinoma in situ without ductal carcinoma in situ or invasive carcinoma diagnosed in core biopsies from 1996 to 2006. Subsequent excision was performed in 41% (136/333) of cases, including atypical lobular hyperplasia (n ¼ 48), lobular carcinoma in situ (n ¼ 39), and lobular neoplasia associated with atypical ductal hyperplasia (n ¼ 49). Upgrades were identified in 2% (1/48) of atypical lobular hyperplasia, 23% (9/39) of lobular carcinoma in situ, and 27% (13/49) of lobular neoplasia associated with atypical ductal hyperplasia cases. When further analyzed, the upgraded cases of lobular carcinoma in situ were associated with radiologic-pathologic discordance in 6/9 cases and with nonclassic pathology (two lobular carcinoma in situ with necrosis and one pleomorphic lobular carcinoma in situ) in the remaining three cases. The frequency of upgrade was 11% (3/26) in classic lobular carcinoma in situ, and 46% (6/13) in nonclassic types (pleomorphic or with necrosis). After excluding cases with discordant imaging/ pathology, there was a 5% upgrade in our excisional specimens. After excluding cases where the upgrade was associated with nonclassic morphology, the upgrade in our study was 1%. Our results suggest that atypical lobular hyperplasia and classic lobular carcinoma in situ with concordant radiology and pathology can be appropriately managed with clinical follow-up without surgery.

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Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow‐up in a multidisciplinary setting

et al. 2014

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We evaluated the efficacy of using standard radiologic and histologic criteria to guide the follow-up of patients with lobular carcinoma in situ (LCIS), lobular neoplasia (LN), or atypical lobular hyperplasia (ALH). Patients with high-risk benign lesions diagnosed on biopsy were presented and reviewed in a multidisciplinary clinical management conference from 1 November 2003 through September 2011. Associations between patient characteristics and rates of upgrade were determined by univariate and multivariate logistic models, and times to diagnosis carcinoma were calculated. Of 853 cases reviewed, 124 (14.5%) were lobular neoplasms. In all, 104 patients were clinically and/or radiographically monitored. In 20 patients, who were found to have LN on core biopsy and were recommended to have immediate surgical excision, a more significant lesion was identified in 8 (40%) of the excised specimens. Factors associated with a more significant lesion on excisional biopsy included whether the lobular lesion had been targeted for biopsy and whether the extent of disease involved three or more terminal duct lobular units. Of the 104 patients radiographically and clinically monitored, the median follow-up time was 3.4 years with a range of 0.44–8.6 years. Five patients under surveillance were subsequently diagnosed with breast malignancy (three of the five at a site unrelated to the initial biopsy). Patients with incidental lobular lesions identified on percutaneous core needle biopsy have a small risk of upgrade and may not require an excisional biopsy. Clinical management of low-volume lobular lesions in a multidisciplinary setting is an efficacious alternative to surgical excision when radiologic and histologic characteristics are well-defined.

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Lobular neoplasia on core‐needle biopsy—Clinical significance

Abstract: BACKGROUND.Approximately 25% of all cases of atypical ductal hyperplasia (ADH)

Cited by 109 publications

References 39 publications

Lobular neoplasia on core needle biopsy does not require excision

Lobular neoplasia on core needle biopsy does not require excision

Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary

Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow‐up in a multidisciplinary setting

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