Management of lobular carcinoma in-situ and atypical lobular hyperplasia of the breast–A review

Abstract

To cite this version:M. Hussain, G.H. Cunnick. Management of lobular carcinoma in situ and atypical lobular hyperplasia of the breast -A review. EJSO -European Journal of Surgical Oncology, WB Saunders, 2011, 37 (4) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.We are submitting the article "Management of Lobular Neoplasia in Situ and Atypical Lobular Hyperplasia -A Review" to your auspicious journal with your kind permission. We have made an effort in an attempt to address the management controversies surrounding lobular Neoplasia on reviewing the currently available literature and have made some management recommendations based on the evidence available.We have also declared no funding and no conflict of interest on the authors' form.Whilst, I (Mubashar Hussain) remain the first author for the paper, Mr G Cunnick could be kindly contacted for correspondence. malignancy. 29% of the unspecified LNs were upgraded to malignancy. The higher incidence of malignancy within excision specimens for LCIS and PLCIS compared to ALH was significant (P<0.04, <0.003 respectively). Conclusion:There is a significant under-estimation of malignancy in patients diagnosed with breast LN on CNB. 27% cases of CNB-diagnosed LN were found to contain malignancy following surgical excision. All patients diagnosed with LN on CNB should be considered for surgical excision biopsy.

Lesions of uncertain malignant potential (B3) on core biopsy in the NHS Breast Screening Programme: is the screening round relevant?

“…1 Histological features, such as a papillary lesion with atypia 8 and lobular neoplasia 6 have been shown to be associated with higher rates of malignancy, especially if pleomorphic lobular carcinoma in situ is present on core biopsy. 9 In such cases, rates of malignancy following open biopsy may be as high as 40-60%. In contrast, a papillary lesion with no atypia seen on core biopsy has a less than 5% chance of malignancy.…”

UK national survey of management of breast lobular carcinoma in situ

“…4 These clinical practice guidelines recommend annual mammographic screening and clinical breast examinations every 6-12 months in addition to MRI. 10 Although LCIS lesions are characteristically undetectable on mammography, 2 the basis for surveillance is with the aim of detecting malignancy at the earliest point for intervention.…”

“…4 Initially considered a precancerous lesion, the evidence reflects a cumulative risk for ipsilateral invasive carcinoma of 18% after the diagnosis of LCIS and 14% for the contralateral breast. 5 This resulted in the adoption of less invasive forms of management, with surveillance being the most common strategy used.…”

Pathologic Upgrade Rates on Subsequent Excision When Lobular Carcinoma In Situ Is the Primary Diagnosis in the Needle Core Biopsy With Special Attention to the Radiographic Target

“…2013;137:927-935; doi: 10.5858/ arpa.2012-0297-OA) L obular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) are infrequent findings in needle core biopsy samples, occurring in approximately 0.5% to 4% of needle core biopsies. [1][2][3][4][5][6][7][8][9][10] Finding LCIS/ALH as the primary, most clinically significant, pathologic diagnosis on core biopsy is even more uncommon. Currently, the surgical management of patients with a primary diagnosis of LCIS or ALH in needle core biopsy samples is controversial and without consensus.…”