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Lobular In-Situ Neoplasia on Breast Core Needle Biopsy: Imaging Indication and Pathologic Extent Can Identify Which Patients Require Excisional Biopsy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The surgical management of lobular in-situ neoplasia (LN) identified by core needle biopsy (CNB) is currently variable. Our institution has routinely excised LN on CNB since 2003, allowing for an unbiased assessment of upgrade rates.

Methods

Cases of LN on CNB, including atypical lobular hyperplasia (ALH) and lobular carcinoma-in-situ (LCIS), were identified in our pathology database. CNBs with concurrent pleomorphic LCIS, ductal carcinoma-in-situ (DCIS), and invasive carcinoma were excluded. Imaging indication/modality, biopsy indication, and radiologic concordance were determined. Pathology review included scoring total foci of LN in each CNB. Upgrade rates to invasive carcinoma or DCIS at excision were calculated.

Results

A total of 106 cases of LN (73 ALH and 33 LCIS) on CNB were identified. Thirty patients had concurrent atypical ductal hyperplasia (ADH) and 76 had LN alone; 93 (88%) of the patients had available surgical follow-up (25 LN + ADH and 68 LN alone). The upgrade rate at excision was 16% (4 of 25) for LN + ADH and 4.4% (3 of 68) for LN alone. Patients with LN alone and discordant imaging, imaging for high-risk indications, or extensive LCIS (>4 foci) accounted for all the upgrades. Normal-risk patients who underwent biopsy to assess calcifications found by routine mammographic screening with LN alone did not result in upgrade.

Conclusions

Women with a CNB diagnosis of LN for calcifications found on routine, normal-risk mammographic screening have a negligible risk of upgrade and may not require excisional biopsy. However, excisional biopsy should be offered to women undergoing imaging for other indications or with >4 foci of LN on CNB.

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References

  1. Foote FW, Stewart FW. Lobular carcinoma in situ: a rare form of mammary cancer. Am J Pathol. 1941;17:491–6.

    PubMed  CAS  Google Scholar 

  2. Haagensen CD, Lane N, Lattes R, Bodian C. Lobular neoplasia (so-called lobular carcinoma in situ) of the breast. Cancer. 1978;42:737–69.

    Article  PubMed  CAS  Google Scholar 

  3. Elsheikh TM, Silverman JF. Follow-up surgical excision is indicated when breast core needle biopsies show atypical lobular hyperplasia or lobular carcinoma in situ. Am J Surg Pathol. 2005;29:1685–6.

    Article  Google Scholar 

  4. Page DL, Dupont WD, Rogers LW, Rados MS. Atypical hyperplastic lesions of the female breast. A long-term follow-up study. Cancer. 1985;55:2698–708.

    Article  PubMed  CAS  Google Scholar 

  5. Page DL, Kidd TE Jr, Dupont WD, Simpson JF, Rogers LW. Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol. 1991;22:1232–9.

    Article  PubMed  CAS  Google Scholar 

  6. Page DL, Dupont WD, Rogers LW. Ductal involvement by cells of atypical lobular hyperplasia in the breast: a long-term follow-up study of cancer risk. Hum Pathol. 1988;19:201–7.

    Article  PubMed  CAS  Google Scholar 

  7. Page DL, Schuyler PA, Dupont WD, Jensen RA, Plummer WD Jr, Simpson JF. Atypical lobular hyperplasia as a unilateral predictor of breast cancer risk: a retrospective cohort study. Lancet. 2003;361(9352):125–9.

    Article  PubMed  Google Scholar 

  8. Lakhani SR. In-situ lobular neoplasia: time for an awakening. Lancet. 2003;361 (9352):96.

    Article  PubMed  Google Scholar 

  9. Lakhani SR, Audretsch W, Cleton-Jensen AM, et al. The management of lobular carcinoma in situ (LCIS). Is LCIS the same as ductal carcinoma in situ (DCIS)? Eur J Cancer. 2006;42:2205–11.

    Article  PubMed  Google Scholar 

  10. Rosen PP, Kosloff C, Lieberman PH, Adair F, Braun DW Jr. Lobular carcinoma in situ of the breast. Detailed analysis of 99 patients with average follow-up of 24 years. Am J Surg Pathol. 1978;2:225–51.

    Article  PubMed  CAS  Google Scholar 

  11. Rosen PP, Senie R, Schottenfeld D, Ashikari R. Noninvasive breast carcinoma: frequency of unsuspected invasion and implications for treatment. Ann Surg. 1979;189:377–82.

    Article  PubMed  CAS  Google Scholar 

  12. Vogel VG, Costantino JP, Wickerham DL, et al. Carcinoma in situ outcomes in National Surgical Adjuvant Breast and Bowel Project Breast Cancer Chemoprevention trials. J Natl Cancer Inst Monogr. 2010;41:181–6.

    Article  Google Scholar 

  13. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371–88.

    Article  PubMed  CAS  Google Scholar 

  14. Venkitaraman R. Lobular neoplasia of the breast. Breast J. 2010;16:519–28.

    Article  PubMed  Google Scholar 

  15. Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Wolmark N. The study of tamoxifen and raloxifene: preliminary enrollment data from a randomized breast cancer risk reduction trial. Clin Breast Cancer. 2002;3:153–9.

    Article  PubMed  Google Scholar 

  16. Berg WA, Mrose HE, Ioffe OB. Atypical lobular hyperplasia or lobular carcinoma in situ at core-needle breast biopsy. Radiology. 2001;218:503–9.

    PubMed  CAS  Google Scholar 

  17. Arpino G, Allred DC, Mohsin SK, Weiss HL, Conrow D, Elledge RM. Lobular neoplasia on core-needle biopsy—clinical significance. Cancer. 2004;101:242–50.

    Article  PubMed  Google Scholar 

  18. Chikman B, Lavy R, Davidson T, et al. Factors affecting rise in the incidence of infiltrating lobular carcinoma of the breast. Isr Med Assoc J. 2010;12:697–700.

    PubMed  Google Scholar 

  19. Anderson E, Berg J, Black R, et al. Prospective surveillance of women with a family history of breast cancer: auditing the risk threshold. Br J Cancer. 2008;98:840–4.

    Article  PubMed  CAS  Google Scholar 

  20. Nagi CS, O’Donnell JE, Tismenetsky M, Bleiweiss IJ, Jaffer SM. Lobular neoplasia on core needle biopsy does not require excision. Cancer. 2008;112:2152–8.

    Article  PubMed  Google Scholar 

  21. Liberman L, Sama M, Susnik B, et al. Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings. AJR Am J Roentgenol. 1999;173:291–9.

    PubMed  CAS  Google Scholar 

  22. Philpotts LE, Shaheen NA, Jain KS, Carter D, Lee CH. Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology. 2000;216:831–7.

    PubMed  CAS  Google Scholar 

  23. D’Orsi CJ, Mendelson EB, Ikeda DM. ACR breast imaging and reporting data system: breast imaging atlas. Reston: American College of Radiology; 2003.

    Google Scholar 

  24. Wang LC, DeMartini WB, Partridge SC, Peacock S, Lehman CD. MRI-detected suspicious breast lesions: predictive values of kinetic features measured by computer-aided evaluation. AJR Am J Roentgenol. 2009;193:826–31.

    Article  PubMed  Google Scholar 

  25. Eby PR, Lehman CD. Magnetic resonance imaging–guided breast interventions. Top Magn Reson Imaging. 2008;19:151–62.

    Article  PubMed  Google Scholar 

  26. Page DL, Anderson TJ. Diagnostic histopathology of the breast. New York: Churchill Livingstone; 1987.

    Google Scholar 

  27. Rosen PP. Rosen’s breast pathology. Philadelphia: Lippincott Williams & Wilkins; 2001.

    Google Scholar 

  28. Sneige N, Wang J, Baker BA, Krishnamurthy S, Middleton LP. Clinical, histopathologic, and biologic features of pleomorphic lobular (ductal-lobular) carcinoma in situ of the breast: a report of 24 cases. Mod Pathol. 2002;15:1044–50.

    Article  PubMed  Google Scholar 

  29. Middleton LP, Grant S, Stephens T, Stelling CB, Sneige N, Sahin AA. Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised? Mod Pathol. 2003;16:120–9.

    Article  PubMed  Google Scholar 

  30. Mahoney MC, Robinson-Smith TM, Shaughnessy EA. Lobular neoplasia at 11-gauge vacuum-assisted stereotactic biopsy: correlation with surgical excisional biopsy and mammographic follow-up. AJR Am J Roentgenol. 2006;187:949–54.

    Article  PubMed  Google Scholar 

  31. Foster MC, Helvie MA, Gregory NE, Rebner M, Nees AV, Paramagul C. Lobular carcinoma in situ or atypical lobular hyperplasia at core-needle biopsy: is excisional biopsy necessary? Radiology. 2004;231:813–9.

    Article  PubMed  Google Scholar 

  32. Brem RF, Lechner MC, Jackman RJ, et al. Lobular neoplasia at percutaneous breast biopsy: variables associated with carcinoma at surgical excision. AJR Am J Roentgenol. 2008;190:637–41.

    Article  PubMed  Google Scholar 

  33. Menon S, Porter GJ, Evans AJ, et al. The significance of lobular neoplasia on needle core biopsy of the breast. Virchows Arch. 2008;452:473–9.

    Article  PubMed  CAS  Google Scholar 

  34. Shin SJ, Rosen PP. Excisional biopsy should be performed if lobular carcinoma in situ is seen on needle core biopsy. Arch Pathol Lab Med. 2002;126:697–701.

    PubMed  Google Scholar 

  35. Crisi GM, Mandavilli S, Cronin E, Ricci A Jr. Invasive mammary carcinoma after immediate and short-term follow-up for lobular neoplasia on core biopsy. Am J Surg Pathol. 2003;27:325–33.

    Article  PubMed  Google Scholar 

  36. Hwang H, Barke LD, Mendelson EB, Susnik B. Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary. Mod Pathol. 2008;21:1208–16.

    Article  PubMed  Google Scholar 

  37. Esserman LE, Lamea L, Tanev S, Poppiti R. Should the extent of lobular neoplasia on core biopsy influence the decision for excision? Breast J. 2007;13:55–61.

    Article  PubMed  Google Scholar 

  38. Cangiarella J, Guth A, Axelrod D, et al. Is surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy?: a report of 38 cases and review of the literature. Arch Pathol Lab Med. 2008;132:979–83.

    PubMed  Google Scholar 

  39. Yeh IT, Dimitrov D, Otto P, Miller AR, Kahlenberg MS, Cruz A. Pathologic review of atypical hyperplasia identified by image-guided breast needle core biopsy. Correlation with excision specimen. Arch Pathol Lab Med. 2003;127:49–54.

    PubMed  Google Scholar 

  40. Renshaw AA, Cartagena N, Derhagopian RP, Gould EW. Lobular neoplasia in breast core needle biopsy specimens is not associated with an increased risk of ductal carcinoma in situ or invasive carcinoma. Am J Clin Pathol. 2002;117:797–9.

    Article  PubMed  Google Scholar 

  41. Port ER, Park A, Borgen PI, Morris E, Montgomery LL. Results of MRI screening for breast cancer in high-risk patients with LCIS and atypical hyperplasia. Ann Surg Oncol. 2007;14:1051–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anatomic Pathology, University of Washington Medical Center, Seattle, WA, USA

    Mara H. Rendi, Suzanne M. Dintzis & Kimberly H. Allison

  2. Department of Radiology, University of Washington Medical Center, Seattle, WA, USA

    Constance D. Lehman

  3. Department of Surgery, University of Washington Medical Center, Seattle, WA, USA

    Kristine E. Calhoun

  4. Seattle Cancer Care Alliance, Seattle, WA, USA

    Constance D. Lehman & Kristine E. Calhoun

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  1. Mara H. Rendi
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  2. Suzanne M. Dintzis
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  3. Constance D. Lehman
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  4. Kristine E. Calhoun
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  5. Kimberly H. Allison
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Correspondence to Kimberly H. Allison.

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Rendi, M.H., Dintzis, S.M., Lehman, C.D. et al. Lobular In-Situ Neoplasia on Breast Core Needle Biopsy: Imaging Indication and Pathologic Extent Can Identify Which Patients Require Excisional Biopsy. Ann Surg Oncol 19, 914–921 (2012). https://doi.org/10.1245/s10434-011-2034-3

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  • DOI: https://doi.org/10.1245/s10434-011-2034-3

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