Careful Radiology Pathology Correlation in Breast Biopsies with Lobular Neoplasia Aids in Triaging for Lumpectomy or Observation
K Atkins, S Rao, E Boeding, M Cohen. University of Virginia, Charlottesville, VA; University of Virgini, Charlottesville, VA
Background: Lumpectomy for noninvasive lobular neoplasia on core biopsy is controversial. Lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) are usually incidental findings, yet, some studies suggest that these findings alone on core bioppsy are associated with an increased incidence of more aggressive lesions on lumpetcomy. At our institution the majority of core biopsies with ALH or LCIS diagnoses are excised, giving an excellent opportunity for a retrospective review to assess the need for reflexive excision in the setting of detailed radiographic and pathologic correlation.
Design: 52 breast core biopsies with a diagnosis of ALH or LCIS only were used (cases with concurrent atypical ductal hyperplasia or worse were excluded). All authors were blinded to the excision results. Histology and imaging were reviewed simultaneously with the pathologist and radiologist discussing imaging abnormalities and histologic correlates. If the lobular neoplasia was questioned to be ductal, E-Cadherin immunohistochemistry was utilized. All cases were then classified as "excision warranted" or "observation only". Pleomorphic lobular carcinoma and florid LCIS (greater than 10 lobules with LCISon core) were placed in the excision group since some have speculated these have an aggressive biologic potential. After review of all images and core biopsy histology, the excsions results were unblinded.
Results: Of the 53 cases 43 had excisions. 37 cases had concordant imaging and histology that warranted observation only. 30/37 had subsequent excisions; 4 had atyipical ductal hyperplasia but none had carcinoma on excision. 6 cases were discordant radiographically (1 secondary to BiRads 5 interpretation, 2 due to lack of explanation for calcifications and and 3 due to no explanation for a mass); 2/6 had DCIS on excision. 4 cases had changes in histology (one to cancerization of the lobule by DCIS and 3 with flat epithelial atypia) and the first case had DCIS on excision. 6 cases had either pleomorphic LCIS or florid LCIS.
Conclusions: When detailed radiographic and histologic correlation is made and an explanation for the radiographic findings found, core biopsies with ALH or LCIS can be safely managed with observation. Core biosies with ALH and LCIS but otherwise bengin biopsies require detailed histologic findings so that accurate radiographic correlation can ensue, particularly quantity of microcalcifications and etiology for a mass.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 29, Wednesday Morning