Outcomes of Prospective Excision for Classic LCIS and ALH on Percutaneous Breast Core Biopsy.
Chad Luedtke, Melissa Murray, Tatjana Nehhozina, Muzaffar Akram, Laura Liberman, Edi Brogi. Memorial Sloan-Kettering Cancer Center, New York, NY
Background: There is no consensus regarding the need for follow-up excision (EXC) of CBs with only classic lobular neoplasia (cLN)[atypical lobular hyperplasia (ALH) or classic lobular carcinoma in situ (cLCIS)] and concordant radio-pathologic findings. Few small retrospective series report upgrade to carcinoma in up to 25% of patients (pts) with EXC, but data are limited by possible selection bias. Pts with cLN on CB undergo prospective EXC at our center since 6/2004. We report our experience with these cases and assess their rate of upgrade to carcinoma [DCIS or invasive carcinoma] on EXC.
Design: Search of the pathology database identified 957pts with CB diagnosis (DX) of cLN between 6/2004 and 5/2009. We excluded from the study pts whose CB had other lesion(s) routinely managed with EXC, pts with no follow up EXC, and pts with CB and/or EXC at another center, to exclude any selection bias. A radiologist examined the pertinent imaging studies of all pts with possible upgrade, and excluded pts with discordant radio-pathologic findings. All slides of CBs and EXCs with an upgrade were reviewed. ALH and cLCIS DX followed Page's criteria. Immunoperoxidase studies for E-cadherin, p120, and b-catenin were performed on cLN of all CBs with upgrade and in the matched EXCs. Clinical data were extracted from medical records. The 95% confidence intervals (CI) were calculated.
Results: Of 80 pts with CB DX of cLN alone, 2 pts had 2 CBs of cLN alone and 11 (13%) were excluded from the study due to discordant CB and radiologic findings. Our study cohort consists of 69 women (71 CBs), with mean age 53 y (range 31-73). The CB targeted Ca2+ in 47/71 (66%), a mass in 7/71 (10%), and MRI enhancement in 17/71 (24%). Of the 69 pts who had prospective EXC for cLN only, 24 (34%) had a history of breast carcinoma (1 ipsilateral, 23 contralateral; 16 invasive ductal, 3 invasive lobular, 1 invasive mixed ductal/lobular, 4 DCIS). Carcinoma was present in 2/71 (3%; 95% CI, 0-10%) EXCs as a 2.3 mm tubular carcinoma with adjacent 2 mm DCIS, and a 2 mm focus of low to intermediate nuclear grade DCIS. Both index CBs contained ALH, and IHC results supported the DX.
Conclusions: Prospective EXC of cLN alone in a CB had an upgrade rate of 3% (95% CI, 0-10%), and yielded only minute foci of low grade carcinoma. Our data provide the most accurate and unbiased estimate of risk of underlying carcinoma in pts with CB diagnosis of cLN and no other reason for EXC, and constitute a fundamental reference for their management.
Monday, February 28, 2011 11:45 AM
Platform Session: Section C, Monday Morning