Incidental Minimal Atypical Lobular Hyperplasia on Core Needle Biopsy: Correlation with Findings on Follow-Up Excision
AP Subhawong, TK Subhawong, N Khouri, T Tsangaris, H Nassar. The Johns Hopkins Hospital, Baltimore, MD
Background: Atypical lobular hyperplasia (ALH) is usually an incidental finding in breast core biopsies (CB) that are performed for microcalcifications or mammographic densities. ALH is largely considered to be a risk factor for invasive carcinoma rather than a direct carcinoma precursor. There are relatively few series that focus on the management of ALH identified on CB, the results of which are controversial. Moreover, ALH is not separated from LCIS in these studies. We review our experience with incidental minimal ALH diagnosed on CB over the past 10 years, and correlate with follow-up excision results.
Design: We evaluated all cases of ALH diagnosed on CB from 1999-2009, only including cases that 1) had 3 or fewer foci of ALH (minimal ALH) on CB not associated with discordant calcifications or a mass 2) had follow-up excision; and 3) did not contain another lesion that by itself would require excision (such as atypical ductal hyperplasia (ADH) or intraductal papilloma). Cases in which the clinical and radiological impressions suggested that a mass lesion had been missed on CB, or in which the calcifications seen on mammography did not match those seen in the CB, were excluded. Therefore the excisional biopsies in these cases were performed because of the diagnosis of ALH.
Results: We identified 39 cases of incidental minimal ALH during this time period. Thirty-four CB (87%) were performed for microcalcifications, with the remaining 5 (13%) done for a mass or other radiographic abnormality. On follow-up excision, 23 cases (59%) showed residual ALH and 14 cases (36%) were benign. Only 2 cases had atypical lesions other than ALH (5%): 1 case had LCIS, and 1 case had focal mild ADH away from the biopsy site.
Conclusions: In our retrospective series, none of the cases had a lesion on excision that would have required further treatment, suggesting that these patients could have been managed more conservatively. We propose that minimal incidental ALH (limited to 3 or fewer foci) on CB does not require re-excision, if there is close radiological correlation, clinical observation, and follow-up.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 32, Wednesday Morning