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

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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.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital,, 100 E 77th Street, New York, NY, 10075, USA

    Iskender Sinan Genco & Sabina Hajiyeva

  2. Department of Surgery, Northwell Health Lenox Hill Hospital,, New York, NY, USA

    Bugra Tugertimur & Lauren Cassell

  3. Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Qing Chang

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  1. Iskender Sinan Genco
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  2. Bugra Tugertimur
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  3. Qing Chang
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  4. Lauren Cassell
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  5. Sabina Hajiyeva
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Contributions

ISG conceived, designed, and analyzed the data and wrote the manuscript. SH designed, edited, and reviewed the manuscript and supervised the study. BT analyzed the data and edited and reviewed the manuscript. CQ collected some of the histologic slides and edited and reviewed the manuscript. LC edited and reviewed the manuscript. All the authors gave final approval for publication. ISG takes full responsibility for the work as a whole including the decision to submit and publish the manuscript.

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Correspondence to Iskender Sinan Genco.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Genco, I.S., Tugertimur, B., Chang, Q. et al. Outcomes of classic lobular neoplasia diagnosed on breast core needle biopsy: a retrospective multi-center study. Virchows Arch 476, 209–217 (2020). https://doi.org/10.1007/s00428-019-02685-8

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  • DOI: https://doi.org/10.1007/s00428-019-02685-8

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