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Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy.
Ann Surg Oncol. 2012 Oct; 19(10):3131-8.AS

Abstract

BACKGROUND

Lobular neoplasia (LN) includes atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS). LN often is an incidental finding on breast core needle biopsy (CNBx) and management remains controversial. Our objective was to define the incidence of malignancy in women diagnosed with pure LN on CNBx, and identify a subset of patients that may be observed.

METHODS

Patients diagnosed with LN on CNB between January 1993 and December 2010 were identified. Patients with an associated high-risk lesion or ipsilateral malignancy at time of diagnosis were excluded. All cases were reviewed by dedicated breast pathologists and breast imagers for pathologic classification and radiologic concordance, respectively.

RESULTS

The study cohort was comprised of 184 (1.3 %) cases of pure LN (147 ALH, 37 LCIS) from 180 patients. Pathologic-radiologic concordance was achieved in 171 (93 %) cases. Excision was performed in 101 (55 %) cases and 83 (45 %) were observed. Mean follow-up was 50.3 (range, 6-212) months. Of cases excised, 1 of 81 (1.2 %) ALH and 1 of 20 (5 %) LCIS cases were upstaged to ductal carcinoma in situ (DCIS) and invasive lobular carcinoma (ILC), respectively. Only 1 of 101 (1 %) concordant lesions was upstaged on excision. Of the cases observed, 4 of 65 (6.2 %) developed ipsilateral cancer during follow-up: 1 of 51 (2 %) case of ALH and 3 of 14 (21.4 %) cases with LCIS (2 ILC, 2 DCIS). During follow-up, 2.9 % (4/138) patients with excised or observed LN developed a contralateral cancer.

CONCLUSIONS

These data support that not all patients with LN diagnosed on CNB require surgical excision. Patients with pure ALH, demonstrating radiologic-pathologic concordance, may be safely observed.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Shah-Khan MG
Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Geiger XJ
No affiliation info available
Reynolds C
No affiliation info available
Jakub JW
No affiliation info available
Deperi ER
No affiliation info available
Glazebrook KN
No affiliation info available

MeSH

AdultAgedAged, 80 and overBiopsy, Large-Core NeedleBreast NeoplasmsCarcinoma in SituCarcinoma, LobularFemaleFollow-Up StudiesHumansHyperplasiaMiddle AgedNeoplasm InvasivenessPrognosisTime Factors

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22847124

Citation

Shah-Khan, Miraj G., et al. "Long-term Follow-up of Lobular Neoplasia (atypical Lobular Hyperplasia/lobular Carcinoma in Situ) Diagnosed On Core Needle Biopsy." Annals of Surgical Oncology, vol. 19, no. 10, 2012, pp. 3131-8.
Shah-Khan MG, Geiger XJ, Reynolds C, et al. Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. Ann Surg Oncol. 2012;19(10):3131-8.
Shah-Khan, M. G., Geiger, X. J., Reynolds, C., Jakub, J. W., Deperi, E. R., & Glazebrook, K. N. (2012). Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. Annals of Surgical Oncology, 19(10), 3131-8. https://doi.org/10.1245/s10434-012-2534-9
Shah-Khan MG, et al. Long-term Follow-up of Lobular Neoplasia (atypical Lobular Hyperplasia/lobular Carcinoma in Situ) Diagnosed On Core Needle Biopsy. Ann Surg Oncol. 2012;19(10):3131-8. PubMed PMID: 22847124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. AU - Shah-Khan,Miraj G, AU - Geiger,Xochiquetzal J, AU - Reynolds,Carol, AU - Jakub,James W, AU - Deperi,Elizabeth R, AU - Glazebrook,Katrina N, Y1 - 2012/07/31/ PY - 2012/04/16/received PY - 2012/8/1/entrez PY - 2012/8/1/pubmed PY - 2013/2/15/medline SP - 3131 EP - 8 JF - Annals of surgical oncology JO - Ann Surg Oncol VL - 19 IS - 10 N2 - BACKGROUND: Lobular neoplasia (LN) includes atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS). LN often is an incidental finding on breast core needle biopsy (CNBx) and management remains controversial. Our objective was to define the incidence of malignancy in women diagnosed with pure LN on CNBx, and identify a subset of patients that may be observed. METHODS: Patients diagnosed with LN on CNB between January 1993 and December 2010 were identified. Patients with an associated high-risk lesion or ipsilateral malignancy at time of diagnosis were excluded. All cases were reviewed by dedicated breast pathologists and breast imagers for pathologic classification and radiologic concordance, respectively. RESULTS: The study cohort was comprised of 184 (1.3 %) cases of pure LN (147 ALH, 37 LCIS) from 180 patients. Pathologic-radiologic concordance was achieved in 171 (93 %) cases. Excision was performed in 101 (55 %) cases and 83 (45 %) were observed. Mean follow-up was 50.3 (range, 6-212) months. Of cases excised, 1 of 81 (1.2 %) ALH and 1 of 20 (5 %) LCIS cases were upstaged to ductal carcinoma in situ (DCIS) and invasive lobular carcinoma (ILC), respectively. Only 1 of 101 (1 %) concordant lesions was upstaged on excision. Of the cases observed, 4 of 65 (6.2 %) developed ipsilateral cancer during follow-up: 1 of 51 (2 %) case of ALH and 3 of 14 (21.4 %) cases with LCIS (2 ILC, 2 DCIS). During follow-up, 2.9 % (4/138) patients with excised or observed LN developed a contralateral cancer. CONCLUSIONS: These data support that not all patients with LN diagnosed on CNB require surgical excision. Patients with pure ALH, demonstrating radiologic-pathologic concordance, may be safely observed. SN - 1534-4681 UR - https://www.unboundmedicine.com/medline/citation/22847124/Long_term_follow_up_of_lobular_neoplasia__atypical_lobular_hyperplasia/lobular_carcinoma_in_situ__diagnosed_on_core_needle_biopsy_ L2 - https://dx.doi.org/10.1245/s10434-012-2534-9 DB - PRIME DP - Unbound Medicine ER -