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The clinical significance of lobular neoplasia on breast core biopsy.
Am J Surg Pathol. 2007 May; 31(5):717-23.AJ

Abstract

A core biopsy diagnosis of atypical ductal epithelial hyperplasia is upstaged on follow-up excisional biopsy (FUEB) to in situ or invasive carcinoma in about 20% of cases, thus prompting a FUEB. In contrast, upstaging information for a core biopsy diagnosis of pure lobular neoplasia (LN), without mass lesions or other risk-associated lesions is less clear. In this retrospective study, we report the largest consecutive series of patients who had a breast core biopsy diagnosis of LN and a FUEB. Core needle breast biopsies with a diagnosis of LN were retrieved from our files for the period 1999 to 2005, yielding 110 patients. One hundred and one patients had a follow-up surgical excision. Cases of LN with coexisting high-risk lesions (n=9, 10%) were excluded from the study. Patients with associated mass lesions all had benign findings (n=15, 16%) and had no impact on the study results. The remaining 77 core biopsies had no masses or risk lesions and were mammographically Breast Imaging Reporting and Data System 4 (BIRADS) for microcalcifications. Overall, 8/77 (10%) of patients with a radiographic BIRADS 4 image with calcifications and a core biopsy diagnosis of LN on core biopsy were upstaged on FUEB to ductal carcinoma in situ or invasive carcinoma. The numbers upstaged from core biopsies were as follows: atypical lobular hyperplasia (ALH) 4/52 (8%), mixed ALH/lobular carcinoma in situ (LCIS) 1/9 (10%), and pure LCIS 3/16 (19%). A core biopsy of LCIS with neoplastic epithelial calcifications was nearly 3 times more likely to be upstaged on FUEB compared with ALH. We conclude that a finding of LN on breast core biopsy in a patient with a BIRADS 4 image and calcifications is associated with a risk of 8% to 19% of upstaging to a treatable disease on FUEB.

Authors+Show Affiliations

Department of Pathology, Magee-Women's Hospital of UPMC, Pittsburgh, PA 15213, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17460455

Citation

Karabakhtsian, Rouzan G., et al. "The Clinical Significance of Lobular Neoplasia On Breast Core Biopsy." The American Journal of Surgical Pathology, vol. 31, no. 5, 2007, pp. 717-23.
Karabakhtsian RG, Johnson R, Sumkin J, et al. The clinical significance of lobular neoplasia on breast core biopsy. Am J Surg Pathol. 2007;31(5):717-23.
Karabakhtsian, R. G., Johnson, R., Sumkin, J., & Dabbs, D. J. (2007). The clinical significance of lobular neoplasia on breast core biopsy. The American Journal of Surgical Pathology, 31(5), 717-23.
Karabakhtsian RG, et al. The Clinical Significance of Lobular Neoplasia On Breast Core Biopsy. Am J Surg Pathol. 2007;31(5):717-23. PubMed PMID: 17460455.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The clinical significance of lobular neoplasia on breast core biopsy. AU - Karabakhtsian,Rouzan G, AU - Johnson,Ronald, AU - Sumkin,Jules, AU - Dabbs,David J, PY - 2007/4/27/pubmed PY - 2007/6/1/medline PY - 2007/4/27/entrez SP - 717 EP - 23 JF - The American journal of surgical pathology JO - Am J Surg Pathol VL - 31 IS - 5 N2 - A core biopsy diagnosis of atypical ductal epithelial hyperplasia is upstaged on follow-up excisional biopsy (FUEB) to in situ or invasive carcinoma in about 20% of cases, thus prompting a FUEB. In contrast, upstaging information for a core biopsy diagnosis of pure lobular neoplasia (LN), without mass lesions or other risk-associated lesions is less clear. In this retrospective study, we report the largest consecutive series of patients who had a breast core biopsy diagnosis of LN and a FUEB. Core needle breast biopsies with a diagnosis of LN were retrieved from our files for the period 1999 to 2005, yielding 110 patients. One hundred and one patients had a follow-up surgical excision. Cases of LN with coexisting high-risk lesions (n=9, 10%) were excluded from the study. Patients with associated mass lesions all had benign findings (n=15, 16%) and had no impact on the study results. The remaining 77 core biopsies had no masses or risk lesions and were mammographically Breast Imaging Reporting and Data System 4 (BIRADS) for microcalcifications. Overall, 8/77 (10%) of patients with a radiographic BIRADS 4 image with calcifications and a core biopsy diagnosis of LN on core biopsy were upstaged on FUEB to ductal carcinoma in situ or invasive carcinoma. The numbers upstaged from core biopsies were as follows: atypical lobular hyperplasia (ALH) 4/52 (8%), mixed ALH/lobular carcinoma in situ (LCIS) 1/9 (10%), and pure LCIS 3/16 (19%). A core biopsy of LCIS with neoplastic epithelial calcifications was nearly 3 times more likely to be upstaged on FUEB compared with ALH. We conclude that a finding of LN on breast core biopsy in a patient with a BIRADS 4 image and calcifications is associated with a risk of 8% to 19% of upstaging to a treatable disease on FUEB. SN - 0147-5185 UR - https://www.unboundmedicine.com/medline/citation/17460455/The_clinical_significance_of_lobular_neoplasia_on_breast_core_biopsy_ L2 - https://doi.org/10.1097/01.pas.0000213408.41182.1f DB - PRIME DP - Unbound Medicine ER -