[265] Lobular Carcinoma In-Situ/Atypical Lobular Hyperplasia on Breast Biopsies: Does It Warrent Surgical Excision?

M O'Neil, R Madan, O Tawfik, P Thomas, I Damjanov, F Fan. University of Kansas Medical Center, Kansas City, KS

Background: Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) are associated with increased risk of developing invasive breast carcinoma in either breast. These changes are often incidental findings in breast core needle biopsies (CNBs). The management of these changes in otherwise benign breast biopsies remains controversial. In this study, we reviewed histologic features of ALH and LCIS in CNBs and correlated biopsy findings with those in the follow-up surgical excisions.
Design: We retrieved 2228 breast CNBs from the surgical pathology files between 2003-2008 and identified 35 cases having a diagnosis of ALH or LCIS (1.6%). Seven cases were excluded due to the presence of more severe lesions on the CNBs which mandated excision. The remaining 28 cases contained only ALH or LCIS and otherwise benign breast tissue; 13 had surgical excision follow up. These cases were retrospectively reviewed for extent of atypical change, ductal spread, and association with microcalcifications. These data were correlated with the follow-up surgical excision findings.
Results: The results are shown in the table below. Five out of 13 cases (38%) were upgraded to a diagnosis of carcinoma at excision. Upon retrospective review, all 5 cases had involvement of ducts by ALH/LCIS and 4 cases had extensive ALH/LCIS in CNB. The coexistence of extensive ALH/LCIS and ALH/LCIS ductal involvement in 7 CNBs was correlated with carcinoma (4/7) or extensive LCIS (3/7) in subsequent excision. ALH/LCIS with/without microcalcifications in CNBs didn't seem to be significant.

Patient	Needle biopsy diagnosis	Microcalcifications	Involvement of Ducts	Extensive (>2 TDLU)	Excision Diagnosis
1	LCIS	Present	Present	Yes	ILC
2	LCIS	Absent	Absent	No	Benign
3	LCIS	Present	Present	Yes	Extensive LCIS
4	LCIS	Absent	Present	No	IDC
5	LCIS	Absent	Present	Yes	DCIS
6	ALH	Present	Present	Yes	IDC and DCIS
7	ALH	Present	Absent	No	Benign
8	LCIS and ALH	Absent	Present	Yes	LCIS
9	LCIS	Present	Absent	Yes	Benign
10	LCIS	Absent	Present	Yes	Extensive LCIS
11	LCIS	Present	Present	Yes	IDC and ILC
12	ALH	Present	Present	No	ALH
13	ALH	Absent	Present	No	LCIS

TDLU terminal ductal lobular unit, DCIS ductal carcinoma in-situ, ILC invasive lobular carcinoma, IDC invasive ductal carcinoma


Conclusions: The histologic diagnosis of ALH/LCIS in breast CNBs should include the extent of the lesion and the presence or absence of ductal involvement. If ALH/LCIS is extensive and involves ducts, excision is warranted.
Category: Breast

Tuesday, March 10, 2009 9:30 AM

Poster Session III # 31, Tuesday Morning