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Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: outcomes of prospective excision.
Cancer. 2013 Mar 01; 119(5):1073-9.C

Abstract

BACKGROUND

No consensus exists on the need to excise breast lesions that yield classic lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) (known together as classic lobular neoplasia [LN]) as the highest risk lesion at percutaneous core-needle biopsy (CNB). Here, the authors report findings from 72 consecutive lesions with LN at CNB and prospective surgical excision (EXB).

METHODS

Lesions that yielded LN at CNB at the authors' center have been referred for EXB since June 2004, regardless of imaging-histologic concordance. A lesion was "concordant" if histologic findings provided sufficient explanation for imaging. An upgrade consisted of ductal carcinoma in situ and/or invasive carcinoma at EXB. Statistical analysis, including 95% confidence intervals (CIs), was performed.

RESULTS

Between June 2004 and May 2009, CNB of 85 consecutive lesions yielded LN without other high-risk histologies. Eighty of 85 lesions (94%) underwent prospective EXB. Seventy-two of 85 lesions (90%; 42 LCIS, 30 ALH) had concordant imaging-histologic findings. EXB yielded low-grade carcinoma in 2 of 72 cases (3%; 95% CI, 0%-9%). In both patients, stereotactic, 11-gauge, vacuum-assisted biopsy of calcifications yielded calcifications in benign parenchyma and ALH. CNB results were discordant in 8 of 80 lesions (10%; 4 LCIS, 4 ALH), and EXB yielded cancer in 3 of those 8 lesions (38%; 95% CI, 9%-76%). The upgrade rate was significantly higher for discordant lesions versus concordant lesions (38% vs 3%; P < .01).

CONCLUSIONS

Prospective excision of LN identified carcinoma in 3% (95% CI, 0%-9%) of concordant cases versus 38% (95% CI, 9%-76%) of discordant cases. The current data provide an unbiased assessment of the upgrade rate of LN diagnosed at CNB.

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Authors+Show Affiliations

Murray MP
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. murraym@mskcc.org
Luedtke C
No affiliation info available
Liberman L
No affiliation info available
Nehhozina T
No affiliation info available
Akram M
No affiliation info available
Brogi E
No affiliation info available

MeSH

AdultAgedBiopsy, Large-Core NeedleBreast NeoplasmsCarcinoma in SituCarcinoma, LobularFemaleHumansHyperplasiaMiddle AgedPrecancerous ConditionsRadiography

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23132235

Citation

Murray, Melissa P., et al. "Classic Lobular Carcinoma in Situ and Atypical Lobular Hyperplasia at Percutaneous Breast Core Biopsy: Outcomes of Prospective Excision." Cancer, vol. 119, no. 5, 2013, pp. 1073-9.
Murray MP, Luedtke C, Liberman L, et al. Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: outcomes of prospective excision. Cancer. 2013;119(5):1073-9.
Murray, M. P., Luedtke, C., Liberman, L., Nehhozina, T., Akram, M., & Brogi, E. (2013). Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: outcomes of prospective excision. Cancer, 119(5), 1073-9. https://doi.org/10.1002/cncr.27841
Murray MP, et al. Classic Lobular Carcinoma in Situ and Atypical Lobular Hyperplasia at Percutaneous Breast Core Biopsy: Outcomes of Prospective Excision. Cancer. 2013 Mar 1;119(5):1073-9. PubMed PMID: 23132235.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: outcomes of prospective excision. AU - Murray,Melissa P, AU - Luedtke,Chad, AU - Liberman,Laura, AU - Nehhozina,Tatjana, AU - Akram,Muzaffar, AU - Brogi,Edi, Y1 - 2012/11/06/ PY - 2012/03/01/received PY - 2012/07/12/revised PY - 2012/08/06/accepted PY - 2012/11/8/entrez PY - 2012/11/8/pubmed PY - 2013/4/6/medline SP - 1073 EP - 9 JF - Cancer JO - Cancer VL - 119 IS - 5 N2 - BACKGROUND: No consensus exists on the need to excise breast lesions that yield classic lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) (known together as classic lobular neoplasia [LN]) as the highest risk lesion at percutaneous core-needle biopsy (CNB). Here, the authors report findings from 72 consecutive lesions with LN at CNB and prospective surgical excision (EXB). METHODS: Lesions that yielded LN at CNB at the authors' center have been referred for EXB since June 2004, regardless of imaging-histologic concordance. A lesion was "concordant" if histologic findings provided sufficient explanation for imaging. An upgrade consisted of ductal carcinoma in situ and/or invasive carcinoma at EXB. Statistical analysis, including 95% confidence intervals (CIs), was performed. RESULTS: Between June 2004 and May 2009, CNB of 85 consecutive lesions yielded LN without other high-risk histologies. Eighty of 85 lesions (94%) underwent prospective EXB. Seventy-two of 85 lesions (90%; 42 LCIS, 30 ALH) had concordant imaging-histologic findings. EXB yielded low-grade carcinoma in 2 of 72 cases (3%; 95% CI, 0%-9%). In both patients, stereotactic, 11-gauge, vacuum-assisted biopsy of calcifications yielded calcifications in benign parenchyma and ALH. CNB results were discordant in 8 of 80 lesions (10%; 4 LCIS, 4 ALH), and EXB yielded cancer in 3 of those 8 lesions (38%; 95% CI, 9%-76%). The upgrade rate was significantly higher for discordant lesions versus concordant lesions (38% vs 3%; P < .01). CONCLUSIONS: Prospective excision of LN identified carcinoma in 3% (95% CI, 0%-9%) of concordant cases versus 38% (95% CI, 9%-76%) of discordant cases. The current data provide an unbiased assessment of the upgrade rate of LN diagnosed at CNB. SN - 1097-0142 UR - https://www.unboundmedicine.com/medline/citation/23132235/Classic_lobular_carcinoma_in_situ_and_atypical_lobular_hyperplasia_at_percutaneous_breast_core_biopsy:_outcomes_of_prospective_excision_ L2 - https://doi.org/10.1002/cncr.27841 DB - PRIME DP - Unbound Medicine ER -