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Core Breast Biopsies Showing Lobular Carcinoma In Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia.
AJR Am J Roentgenol. 2016 Nov; 207(5):1132-1145.AA

Abstract

OBJECTIVE

The purpose of this article is to determine the upgrade rate to ductal carcinoma in situ (DCIS) or invasive carcinoma at excision at the same site after percutaneous breast biopsy findings of atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) using current imaging and strict pathologic criteria.

MATERIALS AND METHODS

From January 2006 through September 2013, 32,960 breast core biopsies were performed; 1084 (3.3%) core biopsies found ALH or classic LCIS. For 447 lesions in 433 women, this was the only high-risk lesion at that site, with no ipsilateral malignancy, and results of excision were available.

RESULTS

Among the 447 lesions, 22 (4.9%) were malignant at excision, including 10 invasive carcinomas (two grade 2 and eight grade 1; all node negative) and 12 DCIS. The upgrade rate of LCIS was 9.3% (10/108; 95% CI, 5.1-16.2%) and that of ALH was 3.5% (12/339; 95% CI, 2.0-6.1%; p = 0.02). After excluding five cases with radiologic-pathologic discordance and reclassifying one core from ALH to LCIS at review, the upgrade rate for LCIS remained higher (8.4%; 9/107; 95% CI, 4.5-15.2%) than that for ALH (2.4%; 8/335; 95% CI, 1.2-4.6%; p = 0.01).

CONCLUSION

Excision is recommended for LCIS on core biopsy because of its 8.4-9.3% upgrade rate. Excluding discordant cases, patients with other high-risk lesions or concurrent malignancy, the risk of upgrade of ALH was 2.4%. Surveillance at 6, 12, and 24 months can be performed in lieu of excision because a short delay in diagnosis of the few malignancies is not expected to cause harm.

Authors+Show Affiliations

1 Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA. 2 Present address: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Unit 1350, Houston, TX 77030.1 Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA. 3 Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.4 Department of Radiology, Yale University School of Medicine, New Haven, CT.5 Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA.5 Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA. 6 Present address: Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN.1 Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA. 3 Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27532153

Citation

Sen, Lauren Q Chang, et al. "Core Breast Biopsies Showing Lobular Carcinoma in Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia." AJR. American Journal of Roentgenology, vol. 207, no. 5, 2016, pp. 1132-1145.
Sen LQ, Berg WA, Hooley RJ, et al. Core Breast Biopsies Showing Lobular Carcinoma In Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia. AJR Am J Roentgenol. 2016;207(5):1132-1145.
Sen, L. Q., Berg, W. A., Hooley, R. J., Carter, G. J., Desouki, M. M., & Sumkin, J. H. (2016). Core Breast Biopsies Showing Lobular Carcinoma In Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia. AJR. American Journal of Roentgenology, 207(5), 1132-1145.
Sen LQ, et al. Core Breast Biopsies Showing Lobular Carcinoma in Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia. AJR Am J Roentgenol. 2016;207(5):1132-1145. PubMed PMID: 27532153.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Core Breast Biopsies Showing Lobular Carcinoma In Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia. AU - Sen,Lauren Q Chang, AU - Berg,Wendie A, AU - Hooley,Regina J, AU - Carter,Gloria J, AU - Desouki,Mohamed M, AU - Sumkin,Jules H, Y1 - 2016/08/17/ PY - 2016/10/22/pubmed PY - 2017/8/18/medline PY - 2016/8/18/entrez KW - atypical lobular hyperplasia KW - lobular carcinoma in situ KW - lobular neoplasia KW - radiologic-pathologic discordance SP - 1132 EP - 1145 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 207 IS - 5 N2 - OBJECTIVE: The purpose of this article is to determine the upgrade rate to ductal carcinoma in situ (DCIS) or invasive carcinoma at excision at the same site after percutaneous breast biopsy findings of atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) using current imaging and strict pathologic criteria. MATERIALS AND METHODS: From January 2006 through September 2013, 32,960 breast core biopsies were performed; 1084 (3.3%) core biopsies found ALH or classic LCIS. For 447 lesions in 433 women, this was the only high-risk lesion at that site, with no ipsilateral malignancy, and results of excision were available. RESULTS: Among the 447 lesions, 22 (4.9%) were malignant at excision, including 10 invasive carcinomas (two grade 2 and eight grade 1; all node negative) and 12 DCIS. The upgrade rate of LCIS was 9.3% (10/108; 95% CI, 5.1-16.2%) and that of ALH was 3.5% (12/339; 95% CI, 2.0-6.1%; p = 0.02). After excluding five cases with radiologic-pathologic discordance and reclassifying one core from ALH to LCIS at review, the upgrade rate for LCIS remained higher (8.4%; 9/107; 95% CI, 4.5-15.2%) than that for ALH (2.4%; 8/335; 95% CI, 1.2-4.6%; p = 0.01). CONCLUSION: Excision is recommended for LCIS on core biopsy because of its 8.4-9.3% upgrade rate. Excluding discordant cases, patients with other high-risk lesions or concurrent malignancy, the risk of upgrade of ALH was 2.4%. Surveillance at 6, 12, and 24 months can be performed in lieu of excision because a short delay in diagnosis of the few malignancies is not expected to cause harm. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/27532153/Core_Breast_Biopsies_Showing_Lobular_Carcinoma_In_Situ_Should_Be_Excised_and_Surveillance_Is_Reasonable_for_Atypical_Lobular_Hyperplasia_ L2 - https://www.ajronline.org/doi/10.2214/AJR.15.15425 DB - PRIME DP - Unbound Medicine ER -