Abstract
Purpose
The management of biopsy proven atypical lobular hyperplasia (ALH) is controversial. Although upgrade rates are low, excisional biopsy is often performed to rule out occult breast cancer.
Methods
In this study, we analyzed our experience with excisional biopsy for ALH diagnosed in the digital tomosynthesis era with radiographic concordance in the community hospital setting. This study included 93 consecutive patients diagnosed with pure ALH on core biopsy from January 2013–December 2017 who underwent subsequent excisional biopsy. Potential clinical, radiographic and pathologic predictors of upgrading were analyzed.
Results
At the time of excisional biopsy, five patients (5.4%) were upgraded to DCIS or invasive breast cancer. There was also a trend towards higher upgrade rates in patients with contralateral breast cancer (p = 0.06), biopsy performed by ultrasound or MRI (p = 0.07) and extensive ALH (p = 0.10). Other clinical, radiographic and pathologic variables were not predictive of upgrade rate (p > 0.1 for all).
Conclusion
Patients with pure ALH with radiographic concordance have a low risk of pathologic upgrading on excisional biopsy. Potential predictors of upgrade rate warrant further analysis in a larger dataset.
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Funding
Research support was provided by the Good Samaritan Hospital Medical Center Foundation.
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All authors contributed to the study conception and design. Data collection and analysis were performed by DL, JK, and PK. All authors read and approved the final manuscript.
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The authors declare that they have no conflict of interest.
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Good Samaritan Hospital Medical Center IRB #16-016 approved this minimal risk registry study with waiver of informed consent. There were no vulnerable populations. This study complies with current laws of the United States government for which it was performed.
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Patient consent for publication was obtained via waiver of informed consent. Informed consent was obtained from all individual participants included in the study.
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Lumley, D., Stokes, D., Karwowski, P. et al. Atypical lobular hyperplasia on core needle biopsy: contemporary results from a large community hospital breast program. Breast Cancer Res Treat 183, 771–774 (2020). https://doi.org/10.1007/s10549-020-05799-9
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DOI: https://doi.org/10.1007/s10549-020-05799-9