The radiological features, diagnosis and management of screen-detected lobular neoplasia of the breast: Findings from the Sloane Project

Maxwell, Anthony; Clements, Karen; Dodwell, David; Evans, Andrew; Francis, Adele; Hussain, Monuwar; Morris, Julie; Pinder, Sarah; Sawyer, Elinor J.; Thomas, Jeremy; Thompson, Alastair

doi:10.1016/j.breast.2016.03.004

Cited by 26 publications

(16 citation statements)

References 55 publications

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“…In line with our findings, the typical median age at LN diagnosis ranges from 50 [19] to 54 years [20]. In our series, 39.6% of patients > 54 years old had an upgrade at definitive histology compared to 15.2% of younger patients (p = 0.006).…”

Section: Discussionsupporting

confidence: 90%

“…In our series, 39.6% of patients > 54 years old had an upgrade at definitive histology compared to 15.2% of younger patients (p = 0.006). A possible explanation of this finding may be that, although LN mainly develops in premenopausal women [20][21][22], it is characterized by a long disease course. Thus, the lesions found in older patients are prone to upgrade into a more aggressive disease.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…LCIS occurs predominantly in premenopausal women, with mean and median age at diagnosis of 49 and 50 years, respectively (range 20s-80s) 10-13 . LCIS is multicentric in 60-80% of patients 14 and bilateral in 20-60% 11, 15, 16 .…”

Section: Clinical Featuresmentioning

confidence: 99%

“…LCIS is multicentric in 60-80% of patients 14 and bilateral in 20-60% 11, 15, 16 . Classic LCIS is clinically and mammographically occult, although recent studies report an association with grouped amorphous or granular mammographic calcifications 13, 17 , or heterogeneous non-mass-like enhancement with persistent enhancement kinetics on MRI 17 . LCIS variants, such as pleomorphic LCIS and LCIS with central necrosis, are usually detected mammographically due to associated pleomorphic calcifications, or can present as a mass lesion with or without associated calcifications 13, 18-25 .…”

Section: Clinical Featuresmentioning

confidence: 99%

Lobular Carcinoma In Situ

Wen

Brogi

2018

Surgical Pathology Clinics

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Lobular carcinoma in situ (LCIS) is a risk factor and a nonobligate precursor of breast carcinoma. The relative risk of invasive carcinoma after classic LCIS diagnosis is approximately 9 to 10 times that of the general population. Classic LCIS diagnosed on core biopsy with concordant imaging and pathologic findings does not mandate surgical excision, and margin status is not reported. The identification of variant LCIS in a needle core biopsy specimen mandates surgical excision, regardless of radiologic-pathologic concordance. The presence of variant LCIS close to the surgical margin of a resection specimen is reported, and reexcision should be considered.

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“…LCIS often remains undetected due to lack of specific clinical and radiological features. Consequently, the diagnosis is mostly based on an accidental finding or mass lesions/calcifications on screening mammography [ [6] , [7] , [8] ]. LCIS is histologically classified into classic, pleomorphic and florid LCIS [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Trends in incidence, treatment, survival and subsequent breast cancer in lobular carcinoma in situ in the Netherlands: A population-based analysis

et al. 2021

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The radiological features, diagnosis and management of screen-detected lobular neoplasia of the breast: Findings from the Sloane Project

Cited by 26 publications

References 55 publications

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

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

Lobular Carcinoma In Situ

Trends in incidence, treatment, survival and subsequent breast cancer in lobular carcinoma in situ in the Netherlands: A population-based analysis

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