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Outcomes of classic lobular neoplasia diagnosed on breast core needle biopsy: a retrospective multi-center study.

Abstract

Management of classic lobular neoplasia (cLN) diagnosed on core needle biopsy (CNB) is controversial. Our aim in this study was to review cases of cLN diagnosed on CNB to determine the rate and risk factors of an upgrade to ductal carcinoma in situ (DCIS) or invasive carcinoma on excision. All breast CNBs with a diagnosis of atypical lobular hyperplasia (ALH) or classic lobular carcinoma in situ (cLCIS) from three different institutions within a single health care system between 2013 and 2018 were retrieved. Cases with any additional high-risk lesions in the same CNB or discordant radiological-pathological correlation were excluded. Information about age, personal history of prior or concurrent breast cancer (P/CBC), and radiological and histological findings were recorded. A total of 287 cLN cases underwent surgical excision. Analysis of these 287 cLN cases showed 11 (3.8%) upgrade lesions on excision. Among the 172 ALH cases, there were 3 (1.7%) upgrades, which were all invasive lobular carcinomas (ILCs). On the other hand, 8 of 115 (7%) cLCIS cases revealed upgrade on excision (2 ILC, 5 DCIS. and 1 ILC + DCIS). Statistical analysis revealed that cLN cases with P/CBC, radiological asymmetry, or architectural distortion had a statistically significant higher upgrade rate on excision. Our findings revealed a low upgrade rate (3.8%) on the excision of classic lobular neoplasia diagnosed on breast core needle biopsy. Clinicoradiological surveillance can be appropriate when lobular neoplasia is identified on core biopsy with pathological radiological concordance in patients without a history of breast cancer, with the caveat that radiological asymmetry and architectural distortion are associated with a significant increase in an upgrade on excision.

Authors+Show Affiliations

Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital,, 100 E 77th Street, New York, NY, 10075, USA. iskendergenco@gmail.com.Department of Surgery, Northwell Health Lenox Hill Hospital,, New York, NY, USA.Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.Department of Surgery, Northwell Health Lenox Hill Hospital,, New York, NY, USA.Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital,, 100 E 77th Street, New York, NY, 10075, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31776645

Citation

Genco, Iskender Sinan, et al. "Outcomes of Classic Lobular Neoplasia Diagnosed On Breast Core Needle Biopsy: a Retrospective Multi-center Study." Virchows Archiv : an International Journal of Pathology, 2019.
Genco IS, Tugertimur B, Chang Q, et al. Outcomes of classic lobular neoplasia diagnosed on breast core needle biopsy: a retrospective multi-center study. Virchows Arch. 2019.
Genco, I. S., Tugertimur, B., Chang, Q., Cassell, L., & Hajiyeva, S. (2019). Outcomes of classic lobular neoplasia diagnosed on breast core needle biopsy: a retrospective multi-center study. Virchows Archiv : an International Journal of Pathology, doi:10.1007/s00428-019-02685-8.
Genco IS, et al. Outcomes of Classic Lobular Neoplasia Diagnosed On Breast Core Needle Biopsy: a Retrospective Multi-center Study. Virchows Arch. 2019 Nov 27; PubMed PMID: 31776645.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of classic lobular neoplasia diagnosed on breast core needle biopsy: a retrospective multi-center study. AU - Genco,Iskender Sinan, AU - Tugertimur,Bugra, AU - Chang,Qing, AU - Cassell,Lauren, AU - Hajiyeva,Sabina, Y1 - 2019/11/27/ PY - 2019/05/23/received PY - 2019/10/09/accepted PY - 2019/09/30/revised PY - 2019/11/29/entrez PY - 2019/11/30/pubmed PY - 2019/11/30/medline KW - Atypical lobular hyperplasia KW - Breast KW - Core biopsy KW - Lobular carcinoma in situ KW - Lobular neoplasia KW - Surgical excision KW - Upgrade JF - Virchows Archiv : an international journal of pathology JO - Virchows Arch. N2 - Management of classic lobular neoplasia (cLN) diagnosed on core needle biopsy (CNB) is controversial. Our aim in this study was to review cases of cLN diagnosed on CNB to determine the rate and risk factors of an upgrade to ductal carcinoma in situ (DCIS) or invasive carcinoma on excision. All breast CNBs with a diagnosis of atypical lobular hyperplasia (ALH) or classic lobular carcinoma in situ (cLCIS) from three different institutions within a single health care system between 2013 and 2018 were retrieved. Cases with any additional high-risk lesions in the same CNB or discordant radiological-pathological correlation were excluded. Information about age, personal history of prior or concurrent breast cancer (P/CBC), and radiological and histological findings were recorded. A total of 287 cLN cases underwent surgical excision. Analysis of these 287 cLN cases showed 11 (3.8%) upgrade lesions on excision. Among the 172 ALH cases, there were 3 (1.7%) upgrades, which were all invasive lobular carcinomas (ILCs). On the other hand, 8 of 115 (7%) cLCIS cases revealed upgrade on excision (2 ILC, 5 DCIS. and 1 ILC + DCIS). Statistical analysis revealed that cLN cases with P/CBC, radiological asymmetry, or architectural distortion had a statistically significant higher upgrade rate on excision. Our findings revealed a low upgrade rate (3.8%) on the excision of classic lobular neoplasia diagnosed on breast core needle biopsy. Clinicoradiological surveillance can be appropriate when lobular neoplasia is identified on core biopsy with pathological radiological concordance in patients without a history of breast cancer, with the caveat that radiological asymmetry and architectural distortion are associated with a significant increase in an upgrade on excision. SN - 1432-2307 UR - https://www.unboundmedicine.com/medline/citation/31776645/Outcomes_of_classic_lobular_neoplasia_diagnosed_on_breast_core_needle_biopsy:_a_retrospective_multi-center_study L2 - https://dx.doi.org/10.1007/s00428-019-02685-8 DB - PRIME DP - Unbound Medicine ER -