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Observation versus excision of lobular neoplasia on core needle biopsy of the breast.
Breast Cancer Res Treat. 2018 Apr; 168(3):649-654.BC

Abstract

PURPOSE

Controversy surrounds management of lobular neoplasia (LN), [atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS)], diagnosed on core needle biopsy (CNB). Retrospective series of pure ALH and LCIS reported "upgrade" rate to DCIS or invasive cancer in 0-40%. Few reports document radiologic/pathologic correlation to exclude cases of discordance that are the likely source of most upgrades, and there is minimal data on outcomes with follow-up imaging and clinical surveillance.

METHODS

Cases of LN alone on CNB (2001-2014) were reviewed. CNB yielding LN with other pathologic findings for which surgery was indicated were excluded. All patients had either surgical excision or clinical follow-up with breast imaging. All cases included were subject to radiologic-pathologic correlation after biopsy.

RESULTS

178 cases were identified out of 62213 (0.3%). 115 (65%) patients underwent surgery, and 54 (30%) patients had surveillance for > 12 months (mean = 55 months). Of the patients who underwent surgical excision, 13/115 (11%) were malignant. Eight of these 13 found malignancy at excision when CNB results were considered discordant (5 DCIS, and 3 invasive lobular carcinoma), with the remainder, 5/115 (4%), having a true pathologic upgrade: 3 DCIS, and 2 microinvasive lobular carcinoma. Among 54 patients not having excision, 12/54 (22%) underwent subsequent CNB with only 1 carcinoma found at the initial biopsy site.

CONCLUSIONS

Surgical excision of LN yields a low upgrade rate when careful consideration is given to radiologic/pathologic correlation to exclude cases of discordance. Observation with interval breast imaging is a reasonable alternative for most cases.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Schmidt H
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, USA. Hank.schmidt@mountsinai.org. Dubin Breast Center of the Tisch Cancer Institute, New York, USA. Hank.schmidt@mountsinai.org.
Arditi B
Dubin Breast Center of the Tisch Cancer Institute, New York, USA.
Wooster M
Dubin Breast Center of the Tisch Cancer Institute, New York, USA.
Weltz C
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, USA. Dubin Breast Center of the Tisch Cancer Institute, New York, USA.
Margolies L
Dubin Breast Center of the Tisch Cancer Institute, New York, USA. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA.
Bleiweiss I
Department of Pathology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
Port E
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, USA. Dubin Breast Center of the Tisch Cancer Institute, New York, USA.
Jaffer S
Dubin Breast Center of the Tisch Cancer Institute, New York, USA. Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, USA.

MeSH

BiopsyBiopsy, Large-Core NeedleBreastBreast Carcinoma In SituFemaleHumansMammographyMiddle AgedPrecancerous ConditionsRetrospective Studies

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29299726

Citation

Schmidt, Hank, et al. "Observation Versus Excision of Lobular Neoplasia On Core Needle Biopsy of the Breast." Breast Cancer Research and Treatment, vol. 168, no. 3, 2018, pp. 649-654.
Schmidt H, Arditi B, Wooster M, et al. Observation versus excision of lobular neoplasia on core needle biopsy of the breast. Breast Cancer Res Treat. 2018;168(3):649-654.
Schmidt, H., Arditi, B., Wooster, M., Weltz, C., Margolies, L., Bleiweiss, I., Port, E., & Jaffer, S. (2018). Observation versus excision of lobular neoplasia on core needle biopsy of the breast. Breast Cancer Research and Treatment, 168(3), 649-654. https://doi.org/10.1007/s10549-017-4629-2
Schmidt H, et al. Observation Versus Excision of Lobular Neoplasia On Core Needle Biopsy of the Breast. Breast Cancer Res Treat. 2018;168(3):649-654. PubMed PMID: 29299726.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Observation versus excision of lobular neoplasia on core needle biopsy of the breast. AU - Schmidt,Hank, AU - Arditi,Brittany, AU - Wooster,Margaux, AU - Weltz,Christina, AU - Margolies,Laurie, AU - Bleiweiss,Ira, AU - Port,Elisa, AU - Jaffer,Shabnam, Y1 - 2018/01/03/ PY - 2017/10/26/received PY - 2017/12/18/accepted PY - 2018/1/5/pubmed PY - 2019/2/28/medline PY - 2018/1/5/entrez KW - Atypical lobular hyperplasia KW - Lobular carcinoma in situ KW - Lobular neoplasia SP - 649 EP - 654 JF - Breast cancer research and treatment JO - Breast Cancer Res Treat VL - 168 IS - 3 N2 - PURPOSE: Controversy surrounds management of lobular neoplasia (LN), [atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS)], diagnosed on core needle biopsy (CNB). Retrospective series of pure ALH and LCIS reported "upgrade" rate to DCIS or invasive cancer in 0-40%. Few reports document radiologic/pathologic correlation to exclude cases of discordance that are the likely source of most upgrades, and there is minimal data on outcomes with follow-up imaging and clinical surveillance. METHODS: Cases of LN alone on CNB (2001-2014) were reviewed. CNB yielding LN with other pathologic findings for which surgery was indicated were excluded. All patients had either surgical excision or clinical follow-up with breast imaging. All cases included were subject to radiologic-pathologic correlation after biopsy. RESULTS: 178 cases were identified out of 62213 (0.3%). 115 (65%) patients underwent surgery, and 54 (30%) patients had surveillance for > 12 months (mean = 55 months). Of the patients who underwent surgical excision, 13/115 (11%) were malignant. Eight of these 13 found malignancy at excision when CNB results were considered discordant (5 DCIS, and 3 invasive lobular carcinoma), with the remainder, 5/115 (4%), having a true pathologic upgrade: 3 DCIS, and 2 microinvasive lobular carcinoma. Among 54 patients not having excision, 12/54 (22%) underwent subsequent CNB with only 1 carcinoma found at the initial biopsy site. CONCLUSIONS: Surgical excision of LN yields a low upgrade rate when careful consideration is given to radiologic/pathologic correlation to exclude cases of discordance. Observation with interval breast imaging is a reasonable alternative for most cases. SN - 1573-7217 UR - https://www.unboundmedicine.com/medline/citation/29299726/Observation_versus_excision_of_lobular_neoplasia_on_core_needle_biopsy_of_the_breast_ DB - PRIME DP - Unbound Medicine ER -