Skip to main content

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)



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.

This is a preview of subscription content, access via your institution.

Fig. 1


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

    PubMed  Google Scholar 

  2. Fisher ER, Land SR, Fisher B, Mamounas E, Gilarski L, Wolmark N. Pathologic findings from the National Surgical Adjuvant Breast and Bowel Project: twelve-year observations concerning lobular carcinoma in situ. Cancer. 2004;100:238–44.

    Article  PubMed  Google Scholar 

  3. Hoda SA (2001) Lobular carcinoma in situ and atypical lobular hyperplasia. In: Rosen PP, editor Rosen’s breast pathology, 2nd ed. Lippincott Williams & Wilkins, Philiadelphia, PA, pp. 581–618.

    Google Scholar 

  4. 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  CAS  PubMed  Google Scholar 

  5. Beute BJ, Kalisher L, Hutter RV. Lobular carcinoma in situ of the breast: clinical, pathologic, and mammographic features. AJR Am J Roentgenol. 1991;157:257–65.

    Article  CAS  PubMed  Google Scholar 

  6. Bauer VP, Ditkoff BA, Schnabel F, Brenin D, El-Tamer M, Smith S. The management of lobular neoplasia identified on percutaneous core breast biopsy. Breast J. 2003;9:4–9.

    Article  PubMed  Google Scholar 

  7. 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 

  8. 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.

    Article  CAS  PubMed  Google Scholar 

  9. O’Driscoll D, Britton P, Bobrow L, Wishart GC, Sinnatamby R, Warren R. Lobular carcinoma in situ on core biopsy—what is the clinical significance? Clin Radiol. 2001;56:216–20.

    Article  PubMed  Google Scholar 

  10. Londero V, Zuiani C, 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.

    Article  PubMed  Google Scholar 

  11. 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 

  12. Dmytrasz K, Tartter PI, Mizrachy H, Chinitz L, Rosenbaum Smith S, Estabrook A. The significance of atypical lobular hyperplasia at percutaneous breast biopsy. Breast J. 2003;9:10–2.

    Article  PubMed  Google Scholar 

  13. 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 

  14. 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 

  15. 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 

  16. Irfan K, Brem RF. Surgical and mammographic follow-up of papillary lesions and atypical lobular hyperplasia diagnosed with stereotactic vacuum-assisted biopsy. Breast J. 2002;8:230–3.

    Article  PubMed  Google Scholar 

  17. 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(6):697−701

    PubMed  Google Scholar 

  18. 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 

  19. 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 

  20. Bonnett M, Wallis T, Rossmann M, et al. Histopathologic analysis of atypical lesions in image-guided core breast biopsies. Mod Pathol. 2003;16:154–60.

    Article  PubMed  Google Scholar 

  21. El-Sheikh TM, Silverman JF. Follow-up surgical excision is indicated when breast core needle biopsies show atypical lobular hyperplasia or lobular carcinoma in situ: a correlative study of 33 patients with review of the literature. Am J Surg Pathol. 2005;29:534–43.

    Article  Google Scholar 

  22. Gradishar WJ, Anderson BO, Balassanian R, et al. Breast cancer, version 2.2015. J Natl Compr Canc Netw. 2015;13:448–75.

    CAS  PubMed  Google Scholar 

  23. Atkins KA, Cohen MA, Nicholson B, Rao S. Atypical lobular hyperplasia and lobular carcinoma in situ at core breast biopsy: use of careful radiologic-pathologic correlation to recommend excision or observation. Radiology. 2013;269:340–7.

    Article  PubMed  Google Scholar 

  24. 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 

  25. Chaudhary S, Lawrence L, McGinty G, Kostroff K, Bhuiya T. Classic lobular neoplasia on core biopsy: a clinical and radio-pathologic correlation study with follow-up excision biopsy. Mod Pathol. 2013;26:762–71.

    Article  PubMed  Google Scholar 

  26. Lewis JL, Lee DY, Tartter PI. The significance of lobular carcinoma in situ and atypical lobular hyperplasia of the breast. Ann Surg Oncol. 2012;19:4124–8.

    Article  PubMed  Google Scholar 

  27. 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 

  28. Niell B, Specht M, Gerade B, Rafferty E. Is excisional biopsy required after a breast core biopsy yields lobular neoplasia? AJR Am J Roentgenol. 2012;199:929–35.

    Article  PubMed  Google Scholar 

  29. Rendi MH, Dintzis SM, Lehman CD, Calhoun KE, Allison 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.

    Article  PubMed  Google Scholar 

  30. Shah-Khan MG, Geiger XJ, Reynolds C, Jakub JW, Deperi ER, Glazebrook KN. Longterm follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. Ann Surg Oncol. 2012;19:3131–8.

    Article  PubMed  Google Scholar 

  31. Zhao C, Desouki MM, Florea A, Mohammed K, Li X, Dabbs D. Pathologic findings of follow-up surgical excision for lobular neoplasia on breast core biopsy performed for calcification. Am J Clin Pathol. 2012;138:72–8.

    Article  PubMed  Google Scholar 

  32. Murray MP, Luedtke C, Liberman L, Nehhozina T, Akram M, Brogi E. Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: outcomes of prospective excision. Cancer. 2013;119:1073–9.

    Article  PubMed  Google Scholar 

  33. Gomes DS, Porto SS, Balabram D, Gobbi H. Inter-observer variability between general pathologists and a specialist in breast pathology in the diagnosis of lobular neoplasia, columnar cell lesions, atypical ductal hyperplasia and ductal carcinoma in situ of the breast. Diagn Pathol. 2014;9:121.

    PubMed Central  Article  PubMed  Google Scholar 

  34. Coopey SB, Mazzola E, Buckley JM, et al. The role of chemoprevention in modifying the risk of breast cancer in women with atypical breast lesions. Breast Cancer Res Treat. 2012;136:627–33.

    Article  CAS  PubMed  Google Scholar 

  35. Barr RG, Zhang Z, Cormack JB, Mendelson EB, Berg WA. Probably benign lesions at screening breast US in a population with elevated risk: prevalence and rate of malignancy in the ACRIN 6666 trial. Radiology. 2013;269:701–12.

    PubMed Central  Article  PubMed  Google Scholar 

Download references


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.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Tari A. King MD.

Additional information

Dr. Stuart J. Schnitt and Dr. Tari A. King share senior authorship of this article.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nakhlis, F., Gilmore, L., Gelman, R. et al. 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). Ann Surg Oncol 23, 722–728 (2016).

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI:


  • Core Biopsy
  • Tubular Carcinoma
  • Lobular Neoplasia
  • Central Pathology Review
  • Atypical Lobular Hyperplasia