Abstract
Background
The significance of lobular neoplasia (LN), lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH)) found at core needle biopsy (CNB) of the breast remains uncertain. There is a consistent risk of underestimating malignancy after the diagnosis of LN on CNB. The aim of this study was to determine if patients with a CNB result of LN need surgical excision.
Methods
Patients were identified by searching the institutions pathology database for the terms “lobular carcinoma in situ” and “atypical lobular hyperplasia” over 20 years. Excluded from this study were those with core needle biopsy (CNB) results of ductal carcinoma in situ, atypical ductal hyperplasia, radial scar, or papilloma. Upgrade was defined as final surgical pathology of invasive carcinoma and/or ductal carcinoma in situ that was directly correlated to the site of the initial biopsy containing LN.
Results
LN was found at CNB in 285 patients, and 71 % (n = 201) had subsequent surgical excisions. All patients with pleomorphic LCIS (pLCIS) underwent surgical excision. Following patients with pLCIS, patients with the diagnosis of LCIS were most likely to undergo surgical excision (80 %). Final pathology of the surgically excised specimens confirmed LN in 72 % (n = 144). Also, 13 % (n = 26) of the operated patients were upgraded to malignancy, including 8 % of ALH and 19 % of LCIS cases.
Conclusion
This is the largest series of surgical excisional pathology following LN on CNB ever reported. The likelihood of finding malignancy at surgical excision after CNB showing LN was 13 %. Patients with the diagnosis of LN on CNB should be considered for surgical excision.
Similar content being viewed by others
References
Foote FW, Stewart PW. Lobular carcinoma in situ: a rare form of mammary carcinoma. Am J Pathol. 1941;17:491–6.
Haagensen CD, Lane N, Lattes R, Bodian C. Lobular neoplasia (so-called lobular carcinoma in situ) of the breast. Cancer. 1978;42:737–69.
Li CI, Anderson BO, Daling JR, Moe RE. Changing incidence of lobular carcinoma in situ of the breast. Breast Cancer Res Treat. 2002;75:259–68.
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.
Liberman L, Sama M, Susnik B, Rosen PP, LaTrenta LR, Morris EA, et al. Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings. Am J Roentgenol. 1999;179:291–9.
Gabriel H. The dilemma of lobular carcinoma in situ at percutaneous biopsy: to excise or to monitor. Am J Roentgenol. 1999;173:300–2.
Schnitt SJ, Morrow M. Lobular carcinoma in situ: current concepts and controversies. Semin Diagn Pathol. 1999;16:209–23.
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.
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.
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.
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.
Rendi MH, Dintzis SM, Lehman CD, Calhoun KE, Allision KH. Lobular in situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. Ann Surg Oncol. 2012;19;914–21.
National Comprehensive Cancer Network (2112). NCCN clinical practice guidelines in oncology: breast cancer. V.1.2012. Available: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 30 Jan 2012.
Rosen PP. Rosen’s Breast Pathology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2001.
Londero V, Zuiani, Linda A, Vianello E, Furlan A, Bazzocchi M. Lobular neoplasia: core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features. Breast. 2008;17:623–30.
Brem R, Behrndt V, Sanow L, Gatewood OM. Atypical ductal hyperplasia: histologic underestimation of carcinoma in tissue harvested from impalpable beast lesions using 11-guage stereotactically guided directional vacuum-assisted biopsy. Am J Roentgenol. 1999;172:1405–7.
Jackman RJ, Nowels KW, Shepard MJ, Finkelstein SI, Marzoni FA. Stereotactic large- core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia. Radiology. 1994;193:91–5.
Liberman L, Cohen MA, Dershaw DD, Abramson AF, Hann LE, Rosen PP. Atypical ductal hyperplasia diagnosed at stereotactic core biopsy of breast lesions: an indication for surgical biopsy. Am J Roentgenol. 1995;164:1111–3.
Houssami N, Ciatto S, Bilious M, Vezzosi V, Bianchi S. Borderline breast cone needle histology: predictive values for malignancy in lesion of uncertain malignant potential (B3). Br J Cancer. 2007;96:1253–7.
Houssami N, Ciatto S, Ellis I, Ambrogetti D. Underestimation of malignancy of the breast core-needle biopsy: concepts and precise overall and category-specific estimates. Cancer. 2007;109:487–95.
Hussain M, Cunnick GH. Management of lobular carcinoma in situ and atypical lobular hyperplasia of the breast- A review. EJSO. 2011;37:279–89.
Vos CB, Clenton-Jansen AM, Berx G, de Leeuw WJ, ter Haar NT, van Roy F, et al. E-cadherin inactivation in lobular carcinoma in situ of the breast: an early event in tumorigenesis. Br J Cancer. 1997;76:1131–3.
Middleton LP, Grant S, Stephens T, Stellings CB, Sneige N, Sahin AA. Lobular carcinoma in situ by core needle biopsy: when should it be excised? Mod Pathol. 2003;16:120–9.
Menon S, Porter GJR, Evans AJ, Ellis IO, Elston CW, Hodi Z, et al. The significance of lobular neoplasia on needle core biopsy of the breast. Virchows Arch. 2008;425:473–9.
Nakhlis F. Upstaging of ALH/LCIS found on core biopsy based on subsequent excisional biopsy. Clinicaltrials.gov. Accessed 21 May 2012.
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.
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.
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.
Karabakhtsian RG, Johnson R, Sumkin J, Dabbs DJ. The clinical significance of lobular neoplasia on breast core biopsy. Am J Surg Pathol. 2007;31:717–23.
Purdie CA, McLean D, Stormonth E. Management of in situ lobular neoplasia detected on needle core biopsy of breast. J Clin Pathol. 2010;63:987–96.
Berg WA, Mrose HE, Ioffe OB. Atypical lobular hyperplasia or lobular carcinoma in situ at core-needle breast biopsy. Radiology. 2001;218:503–9.
Pacelli A, Rhodes DJ, Amrami KK. Outcome of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed by core needle biopsy: clinical and surgical follow-up of 30 cases. Am J Clin Pathol. 2001;116:591–2.
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.
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.
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.
Fadare O, Dadmanesh F, Alvarado-Cabrero I. Lobular intraepithelial neoplasia [lobular carcinoma in situ] with comedo- type necrosis: a clinicopathologic study of 18 cases. Am J Surg Pathol. 2006;30:1445–53.
Hwang H, Barke LD, Mendelson EB, Susnik B. Atypical lobular hyperplasia and classic lobular carcinoma in situ on core biopsy specimens: routine excision is not necessary. Mod Pathol. 2008;21:1208–16.
Cohen MA. Cancer upgrades at excisional biopsy after diagnosis of atypical lobular hyperplasia or lobular carcinoma in city at core-needle biopsy: some reasons why. Radiology. 2004;231:617–21.
Jackman RJ, Birdwell RL, Ikeda DM. Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-guage vacuum-assisted biopsy, eliminating the recommendation for surgical excision? Radiology. 2002;224:548–54.
Disclosures
Nothing to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lewis, J.L., Lee, D.Y. & Tartter, P.I. The Significance of Lobular Carcinoma In Situ and Atypical Lobular Hyperplasia of the Breast. Ann Surg Oncol 19, 4124–4128 (2012). https://doi.org/10.1245/s10434-012-2538-5
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-012-2538-5