Atypical Lobular Hyperplasia in Surgical Margins and Needle Biopsies: A Clinicopathological Study in One Institute
M Kasami, T Uematsu, H Tashiro. Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
Background: Lymph node negative T1 and Tis carcinomas, and atypical lesions in breast specimens, are increasing. Clinical management of detected atypical lesions without associated more aggressive lesions both in needle biopsies and in surgical margin, is still controversial.Some reports maintain that lobular neoplasia are not only a risk factor for invasive carcinoma, but is also a nonobligate precursor.
Design: During the period 2002-2008, 2,976 needle biopsies, 1,335 intraoperative margin evaluations and 1,724 breast surgeries were performed in our institute. We studied cases with atypical lobular hyperplasia (ALH) and ductal involvement of cells of ALH (DIALH) in needle biopsies and at final margins. ALH and lobular carcinoma in situ were differentiated using Page's criteria. E-cadherin immunostaining was used when it was difficult to distinguish between lobular and ductal neoplasia.
Results: Eleven patients with ALH and/or DIALH without associated malignancy were diagnosed by needle biopsies. No pleomorphic ALH was found at the needle biopsy nor at the margins. Four patients did not undergo excisional biopsy and had no suspected imaging changes (follow up 6 months to 4 years). Excisional biopsies were performed on 7 patients. The diagnoses were: Invasive ductal carcinoma(1), ductal carcinoma in situ(2), atypical ductal hyperplasia(1), ALH(2) and benign lesion(1). ALH and/or DIALH extended to the margins in 46 of 287 cases containing ALH in surgical specimen. Therapies were: Radiation (29), hormone therapy (31) and/or chemotherapy(14). Four cases have been followed up without developing imaging lesions for 8 to 78 months (median: 41 months). Two patients in their 40s had recurrences after radiation therapy. One showed multiple carcinomas and the other recurred in the muscle. Neither recurrence was at the surgical site.
Conclusions: We recommend excisional biopsy following a diagnosis of ALH by needle biopsies in order to rule out malignancy. However, when ALH is present at the margins of a surgical and/or intraoperation specimen, intensive follow up using imaging is possible without the necessity of additional surgery.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 31, Wednesday Morning