The Incidence of Invasive Carcinoma and Ductal Carcinoma In Situ Following a Core Biopsy Diagnosis of Lobular Neoplasia
F Chen, C Koenig. New York University School of Medicine, New York, NY; Hackensack University Medical Center, Hackensack, NJ
Background: Lobular neoplasia (LN), encompassing atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), is generally regarded as a risk factor for the subsequent development of invasive carcinoma (IC) in either breast. The clinical management of patients with a core biopsy (CB) diagnosis of LN remains the subject of debate. This dilemma is becoming increasingly common as increasing numbers of image directed CBs are performed for a variety of mammographic and ultrasound findings. Previous studies on this topic have yielded conflicting results and have been confounded by the inclusion of other lesions [e.g., atypical ductal hyperplasia (ADH)] in some of the cases. The aim of this study was to review our institutions incidence of carcinoma on follow-up excisional biopsy (EB) after a CB diagnosis of LN.
Design: 67 breast CBs with a diagnosis of LN, ALH or LCIS, without IC or DCIS, were retrieved from the surgical pathology files of Hackensack University Medical Center from Jan. 1998 to the present. 19 cases were excluded because of the presence of ADH. Of the remaining 48 cases, 13 had a subsequent EB performed within 3 months of the CB. All available slides were reviewed from the CB and the subsequent EB.
Results: Of the 13 CBs examined, 8 were performed for calcifications, 2 for a mass, 2 for a nodule and 1 for an abnormal mammogram. The follow-up EB revealed 2 cases of DCIS, 1 invasive ductal carcinoma (IDC) and 1 invasive lobular carcinoma (ILC). The mammographic findings of the 4 patients with carcinoma were as follows: calcifications alone (DCIS), mass with calcifications (IDC, ILC), and architectural distortion with calcifications (DCIS). The overall incidence of carcinoma following a CB diagnosis of LN is 4/13 (31%).
Conclusions: Our data corroborates the high incidence of carcinoma seen in previous studies on this topic. Since the carcinomas occurred in women with calcifications and in those with a mass, these results strongly support a management strategy advocating EB in all patients with a CB diagnosis of LN.
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 29, Tuesday Morning