Should the Extent of Lobular Neoplasia on Core Biopsy Influence the Decision for Excision?

Mount Sinai Medical Center, New York, New York, United States
The Breast Journal (Impact Factor: 1.41). 01/2007; 13(1):55-61. DOI: 10.1111/j.1524-4741.2006.00363.x
Source: PubMed


The purpose of this study was to determine whether there is a criterion that can be utilized to determine if excisional biopsy is indicated following the diagnosis of lobular neoplasia (LN) on core biopsy. Retrospective review of patient records with diagnosis of LN as highest risk diagnosis on core biopsy was performed. LN was defined to include both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) and was categorized as focal or diffuse. The pathology was correlated with the mammographic finding to determine whether the diagnosis of LN was incidental or related to the mammographic finding. For those patients who did not undergo excision, follow-up data are presented along with treatment information. A total of 4,555 breast core biopsies were performed at our institution from January 1997 through March 2005. Of these, 35 patients were diagnosed with LN. Twenty six (74%) went on to excision and nine (26%) were followed. Biopsy was recommended for mammographically detected calcifications in the majority of cases. Twenty four (92%) of the 26 excised cases had focal LN and 2 of 26 (8%) had diffuse LN. Infiltrating lobular carcinoma was diagnosed in both cases of diffuse LN and no infiltrating carcinoma was seen when focal LN was diagnosed on core. Excision may not be necessary when a diagnosis of only focal LN is made on core biopsy. Diffuse LN may indicate an associated invasive cancer and should prompt excision.

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    • "Previous published studies of simple lobular neoplasia on core biopsy were reviewed [1–3, 6, 9, 10, 12, 14, 16–18, 20, 21, 23, 25, 26, 31, 33, 36, 37, 39, 41–43, 46, 47, 51, 54, 58, 59]. The data in most studies are not representative. "
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    ABSTRACT: The management of a core biopsy diagnosis of lobular neoplasia is controversial. Detailed radiological-pathological review of 47 patients with cores showing classical lobular neoplasia was performed (patients with pleomorphic lobular carcinoma in situ (LCIS) or associated risk lesions were considered separately). Immediate surgical excision in 25 patients showed invasive carcinoma in 7, ductal carcinoma in situ (DCIS) in 1 and pleomorphic LCIS in 1; radiological-pathological review showed that the core biopsy missed a mass in 5, missed calcification in 2 and that calcification appeared adequately sampled in 2. Nineteen patients had follow-up of at least 2 years. Four patients developed malignancy at the site of the core biopsy (invasive carcinoma in three, DCIS in one); one carcinoma was mammographically occult, one patient had dense original mammograms and two had calcifications apparently adequately sampled by the core. In conclusion, most carcinomas identified at the site of core biopsy showing lobular neoplasia were the result of the core missing the radiological lesion, emphasising the importance of multidisciplinary review and investigation of any discordance. Some carcinomas were found after apparently adequate core biopsy, raising the question of whether excision biopsy should be considered after all core biopsy diagnoses of lobular neoplasia.
    Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 06/2008; 452(5):473-9. DOI:10.1007/s00428-008-0607-8 · 2.65 Impact Factor
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    ABSTRACT: Verification of clinical procedure in patients with primary diagnosis of lobular carcinoma in situ and atypical lobular hyperplasia found on the basis of 11-gauge mammotomic biopsy. A retrospective evaluation of 4326 mammotomic biopsies carried out in one clinic by three oncological surgeons in view of the diagnosed lobular carcinoma in situ or atypical lobular hyperplasia without concomitant invasive lesions. Biopsies showed that lobular carcinoma in situ or atypical lobular hyperplasia were concomitant lesions with benign changes of the mammary gland. Of 16 cases of lobular carcinoma in situ, invasive ductal cancer was observed in 2 patients, invasive lobular cancer in 2 patients, and ductal carcinoma in situ in 1 case. Seven patients did not undergo surgery but were kept under intensive oncological supervision. Of 17 cases of atypical lobular hyperplasia, after surgery it turned out that there were 4 cases of invasive ductal cancer and 1 case of ductal carcinoma in situ. Five patients did not undergo surgery but were kept under intensive oncological supervision. After initial mammotomic diagnosis of lobular carcinoma in situ, invasive carcinoma or ductal carcinoma in situ was found in 31.25% of the cases and atypical lobular hyperplasia in 29.4%. This suggests that lobular neoplasia on core needle biopsy should prompt surgery. The open question is what factors are associated with the lower probability of concomitant invasive cancer. It seems that for isolated microcalcifications, which are totally removed in core biopsy, we can offer a close follow-up. We will have to wait for a follow-up longer than 2 years to be sure that surveillance is recommended for totally removed isolated microcalcifications.
    Tumori 01/2009; 95(1):32-5. · 1.27 Impact Factor
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