The lobular neoplasia enigma: management and prognosis in a long follow-up case series

Abstract

Background Many oncologists debate if lobular neoplasia (LN) is a risk factor or an obligatory precursor of more aggressive disease. This study has three aims: (i) describe the different treatment options (surgical resection vs observation), (ii) investigate the upgrade rate in surgically treated patients, and (iii) evaluate the long-term occurrences of aggressive disease in both operated and unoperated patients. Methods A series of 122 patients with LN bioptic diagnosis and follow-up information were selected. Clinical, radiological, and pathological data were collected from medical charts. At definitive histology, either invasive or ductal carcinoma in situ was considered upgraded lesions. Results Atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and high-grade LN (HG-LN) were diagnosed in 44, 63, and 15 patients, respectively. The median follow-up was 9.5 years. Ninety-nine patients were surgically treated, while 23 underwent clinical-radiological follow-up. An upgrade was observed in 28/99 (28.3%). Age ≥ 54 years (OR 4.01, CI 1.42–11.29, p = 0.009), Breast Imaging-Reporting and Data System (BI-RADS) categories 4–5 (OR 3.76, CI 1.37–10.1, p = 0.010), and preoperatory HG-LN diagnosis (OR 8.76, 1.82–42.27, p = 0.007) were related to upgraded/aggressive disease. During follow-up, 8 patients developed an ipsilateral malignant lesion, four of whom were not initially operated (4/23, 17%). Conclusions BI-RADS categories 4–5, HG-LN diagnosis, and age ≥ 54 years were features associated with an upgrade at definitive surgery. Moreover, 17% of unoperated cases developed an aggressive disease, emphasizing that LN patients need close surveillance due to the long-term risk of breast cancer.

Management of Lobular Neoplasia Diagnosed by Core Biopsy

“…Diagnosis upstaging from LCIS to invasive breast cancer or to ductal carcinoma in situ ranges from 2% to 25% [ 10 ]. Metovic et al reported 28.3% in ALH, LCIS, and high-grade LN cases [ 18 ], whereas Singh et al reported 4% upgrade in classic LCIS, which is similar to our own observations [ 19 ]. Laws et al have reported a series of 77 patients with 78 LN lesions, primarily treated with conservative management rather than surgical excision [ 20 ].…”

From women to women—hematuria during therapy for metastatic breast cancer, what to suspect and when to be alarmed; Bladder metastasis from breast cancer—our experience and a systematic literature review

“…Furthermore, biomarker status conversion between primary and metastatic breast cancer tissues is possible, probably due to adjuvant therapy, changing from HR positive to HR negative ( 46 ). Biomarker conversion status is an important factor in the management of these patients as it is associated to different therapeutic strategies and shorter survival ( 67 , 68 ). Although all three of our patients remained weakly positive for the HRs, they lived for 5, 1, and 2 months after the bladder metastases diagnosis, respectively.…”

Urinary bladder metastasis from primary breast cancer, a rare and challenging diagnosis. A case report and literature review

“…Though most of breast cancer originates from the ducts (invasive ductal carcinoma), it is the less common subtype, invasive lobular carcinoma (ILC) that accounts for 5–15% of all breast cancers [ 13 ], that is better known for its unusual sites of metastasis, including the UB [ 14 ]. Invasive lobular carcinoma tends to spread to serosal surfaces, including the peritoneum, and this pattern of spread probably accounts for the majority of breast cancer metastasis to the UB.…”