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Lobular Neoplasia Diagnosed by MRI-Guided Breast Biopsy: Identifying Upgrade Rate to Malignancy and Outcomes of Clinical and Surgical Management

  • Breast Oncology
  • Published:
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Abstract

Objective

The aim of this study was to determine surgical and clinical outcomes of lobular neoplasia (LN) diagnosed by magnetic resonance imaging (MRI) biopsy, including upgrade to malignancy, and to assess for characteristics associated with upgrade.

Method

A single-institution retrospective study, between 2013 and 2022, of patients with histopathological findings of LN via MRI-guided biopsy was performed using an institutional database and review of the electronic medical records. Decision for excision or surveillance was made by a multidisciplinary team per institutional practice. Patient demographics and imaging characteristics were summarized using descriptive analyses. Upgrade was defined as upgrade to cancer on surgical pathology for patients treated with excision or the development of cancer at the biopsy site during surveillance. The Wilcoxon rank-sum test and Fisher’s exact test were used to compare features of the upgraded cohort with the remainder of the group.

Results

Ninety-four MRI biopsies diagnosing LN were included. Median age was 57 years (range 37–78 years). Forty-six lesions underwent excision while 48 lesions were surveilled. The upgrade rate was 7.4% (7/94). Upgrades in the excised cohort consisted of pleomorphic lobular carcinoma in situ (LCIS; n = 1), ductal carcinoma in situ (DCIS; n = 3) and invasive lobular carcinoma (ILC; n = 2), while one interval development of DCIS was observed at the site of biopsy in the surveillance cohort. No MRI or patient variables were associated with upgrade.

Conclusions

In this contemporary cohort of MRI-detected LNs, the upgrade rate was low. Omission of surgery for MRI-detected LNs in carefully selected patients may be considered in a shared decision-making capacity between the patient and the treatment team. Larger cohorts are needed to determine factors predictive of upgrade risk.

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Authors and Affiliations

  1. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Shlermine A. Everidge MD, Mediget Teshome MD, MPH, Nina Tamirisa MD, Susie Sun MD, Taiwo Adesoye MD, Isabelle Bedrosian MD & Puneet Singh MD, MS

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jia Sun MPH

  3. Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Emily Nia MD & Miral Patel MD

  4. Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Therese Bevers MD

Authors
  1. Shlermine A. Everidge MD
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  2. Jia Sun MPH
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  3. Mediget Teshome MD, MPH
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  4. Nina Tamirisa MD
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Corresponding author

Correspondence to Puneet Singh MD, MS.

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Disclosure

Shlermine A. Everidge, Jia Sun, Mediget Teshome, Nina Tamirisa, Susie Sun, Taiwo Adesoye, Emily Nia, Therese Bevers, Isabelle Bedrosian, Miral Patel, and Puneet Singh have no disclosures to declare.

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Everidge, S.A., Sun, J., Teshome, M. et al. Lobular Neoplasia Diagnosed by MRI-Guided Breast Biopsy: Identifying Upgrade Rate to Malignancy and Outcomes of Clinical and Surgical Management. Ann Surg Oncol 31, 2224–2230 (2024). https://doi.org/10.1245/s10434-023-14764-x

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  • DOI: https://doi.org/10.1245/s10434-023-14764-x

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