Annals of Surgical Oncology

, Volume 23, Issue 3, pp 722–728 | Cite as

Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In-situ in Patients with Lobular Neoplasia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 020)

  • Faina Nakhlis
  • Lauren Gilmore
  • Rebecca Gelman
  • Isabelle Bedrosian
  • Kandice Ludwig
  • E. Shelley Hwang
  • Shawna Willey
  • Clifford Hudis
  • J. Dirk Iglehart
  • Elizabeth Lawler
  • Nicole Y. Ryabin
  • Mehra Golshan
  • Stuart J. Schnitt
  • Tari A. King
Breast Oncology



Lobular neoplasia (LN) represents a spectrum of atypical proliferative lesions, including atypical lobular hyperplasia and lobular carcinoma-in-situ. The need for excision for LN found on core biopsy (CB) is controversial. We conducted a prospective multi-institutional trial (TBCRC 20) to determine the rate of upgrade to cancer after excision for pure LN on CB.


Patients with a CB diagnosis of pure LN were prospectively identified and consented to excision. Cases with discordant imaging and those with additional lesions requiring excision were excluded. Upgrade rates to cancer were quantified on the basis of local and central pathology review. Confidence intervals and sample size were based on exact binomial calculations.


A total of 77 of 79 registered patients underwent excision (median age 51 years, range 27–82 years). Two cases (3 %; 95 % confidence interval 0.3–9) were upgraded to cancer (one tubular carcinoma, one ductal carcinoma-in-situ) at excision per local pathology. Central pathology review of 76 cases confirmed pure LN in the CB in all but two cases. In one case, the tubular carcinoma identified at excision was also found in the CB specimen, and in the other, LN was not identified, yielding an upgrade rate of one case (1 %; 95 % CI 0.01–7) by central pathology review.


In this prospective study of 77 patients with pure LN on CB, the upgrade rate was 3 % by local pathology and 1 % by central pathology review, demonstrating that routine excision is not indicated for patients with pure LN on CB and concordant imaging findings.


Core Biopsy Tubular Carcinoma Lobular Neoplasia Central Pathology Review Atypical Lobular Hyperplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We are grateful for the funding support to the TBCRC from the AVON Foundation, the Breast Cancer Research Foundation, and Susan G. Komen.


The authors declare no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Faina Nakhlis
    • 1
    • 8
  • Lauren Gilmore
    • 2
  • Rebecca Gelman
    • 1
  • Isabelle Bedrosian
    • 4
  • Kandice Ludwig
    • 5
  • E. Shelley Hwang
    • 6
  • Shawna Willey
    • 7
  • Clifford Hudis
    • 3
  • J. Dirk Iglehart
    • 1
    • 8
  • Elizabeth Lawler
    • 1
  • Nicole Y. Ryabin
    • 1
  • Mehra Golshan
    • 1
    • 8
  • Stuart J. Schnitt
    • 9
  • Tari A. King
    • 10
  1. 1.Dana-Farber/Harvard Cancer CenterBostonUSA
  2. 2.Mount Auburn HospitalCambridgeUSA
  3. 3.Breast Medicine Service, Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Indiana University Cancer CenterIndianapolisUSA
  6. 6.Duke University Medical CenterDurhamUSA
  7. 7.Georgetown University Cancer CenterWashingtonUSA
  8. 8.Dana-Farber/Brigham and Women’s Cancer CenterBostonUSA
  9. 9.Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  10. 10.Breast Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA

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