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Lobular in-situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy.
Ann Surg Oncol. 2012 Mar; 19(3):914-21.AS

Abstract

BACKGROUND

The surgical management of lobular in-situ neoplasia (LN) identified by core needle biopsy (CNB) is currently variable. Our institution has routinely excised LN on CNB since 2003, allowing for an unbiased assessment of upgrade rates.

METHODS

Cases of LN on CNB, including atypical lobular hyperplasia (ALH) and lobular carcinoma-in-situ (LCIS), were identified in our pathology database. CNBs with concurrent pleomorphic LCIS, ductal carcinoma-in-situ (DCIS), and invasive carcinoma were excluded. Imaging indication/modality, biopsy indication, and radiologic concordance were determined. Pathology review included scoring total foci of LN in each CNB. Upgrade rates to invasive carcinoma or DCIS at excision were calculated.

RESULTS

A total of 106 cases of LN (73 ALH and 33 LCIS) on CNB were identified. Thirty patients had concurrent atypical ductal hyperplasia (ADH) and 76 had LN alone; 93 (88%) of the patients had available surgical follow-up (25 LN + ADH and 68 LN alone). The upgrade rate at excision was 16% (4 of 25) for LN + ADH and 4.4% (3 of 68) for LN alone. Patients with LN alone and discordant imaging, imaging for high-risk indications, or extensive LCIS (>4 foci) accounted for all the upgrades. Normal-risk patients who underwent biopsy to assess calcifications found by routine mammographic screening with LN alone did not result in upgrade.

CONCLUSIONS

Women with a CNB diagnosis of LN for calcifications found on routine, normal-risk mammographic screening have a negligible risk of upgrade and may not require excisional biopsy. However, excisional biopsy should be offered to women undergoing imaging for other indications or with >4 foci of LN on CNB.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Rendi MH
Department of Anatomic Pathology, University of Washington Medical Center, Seattle, WA, USA.
Dintzis SM
No affiliation info available
Lehman CD
No affiliation info available
Calhoun KE
No affiliation info available
Allison KH
No affiliation info available

MeSH

AdultAgedAged, 80 and overBiopsy, NeedleBreast NeoplasmsCarcinoma in SituCarcinoma, LobularFemaleHumansHyperplasiaMagnetic Resonance ImagingMammographyMiddle AgedUltrasonography, Mammary

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21861212

Citation

Rendi, Mara H., et al. "Lobular In-situ Neoplasia On Breast Core Needle Biopsy: Imaging Indication and Pathologic Extent Can Identify Which Patients Require Excisional Biopsy." Annals of Surgical Oncology, vol. 19, no. 3, 2012, pp. 914-21.
Rendi MH, Dintzis SM, Lehman CD, et al. Lobular in-situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. Ann Surg Oncol. 2012;19(3):914-21.
Rendi, M. H., Dintzis, S. M., Lehman, C. D., Calhoun, K. E., & Allison, K. H. (2012). Lobular in-situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. Annals of Surgical Oncology, 19(3), 914-21. https://doi.org/10.1245/s10434-011-2034-3
Rendi MH, et al. Lobular In-situ Neoplasia On Breast Core Needle Biopsy: Imaging Indication and Pathologic Extent Can Identify Which Patients Require Excisional Biopsy. Ann Surg Oncol. 2012;19(3):914-21. PubMed PMID: 21861212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lobular in-situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. AU - Rendi,Mara H, AU - Dintzis,Suzanne M, AU - Lehman,Constance D, AU - Calhoun,Kristine E, AU - Allison,Kimberly H, Y1 - 2011/08/23/ PY - 2011/05/13/received PY - 2011/8/24/entrez PY - 2011/8/24/pubmed PY - 2012/6/13/medline SP - 914 EP - 21 JF - Annals of surgical oncology JO - Ann Surg Oncol VL - 19 IS - 3 N2 - BACKGROUND: The surgical management of lobular in-situ neoplasia (LN) identified by core needle biopsy (CNB) is currently variable. Our institution has routinely excised LN on CNB since 2003, allowing for an unbiased assessment of upgrade rates. METHODS: Cases of LN on CNB, including atypical lobular hyperplasia (ALH) and lobular carcinoma-in-situ (LCIS), were identified in our pathology database. CNBs with concurrent pleomorphic LCIS, ductal carcinoma-in-situ (DCIS), and invasive carcinoma were excluded. Imaging indication/modality, biopsy indication, and radiologic concordance were determined. Pathology review included scoring total foci of LN in each CNB. Upgrade rates to invasive carcinoma or DCIS at excision were calculated. RESULTS: A total of 106 cases of LN (73 ALH and 33 LCIS) on CNB were identified. Thirty patients had concurrent atypical ductal hyperplasia (ADH) and 76 had LN alone; 93 (88%) of the patients had available surgical follow-up (25 LN + ADH and 68 LN alone). The upgrade rate at excision was 16% (4 of 25) for LN + ADH and 4.4% (3 of 68) for LN alone. Patients with LN alone and discordant imaging, imaging for high-risk indications, or extensive LCIS (>4 foci) accounted for all the upgrades. Normal-risk patients who underwent biopsy to assess calcifications found by routine mammographic screening with LN alone did not result in upgrade. CONCLUSIONS: Women with a CNB diagnosis of LN for calcifications found on routine, normal-risk mammographic screening have a negligible risk of upgrade and may not require excisional biopsy. However, excisional biopsy should be offered to women undergoing imaging for other indications or with >4 foci of LN on CNB. SN - 1534-4681 UR - https://www.unboundmedicine.com/medline/citation/21861212/Lobular_in_situ_neoplasia_on_breast_core_needle_biopsy:_imaging_indication_and_pathologic_extent_can_identify_which_patients_require_excisional_biopsy_ L2 - https://dx.doi.org/10.1245/s10434-011-2034-3 DB - PRIME DP - Unbound Medicine ER -