Lobular Neoplasia in Core Biopsy of Breast: Clinical Implications.
Jodi J Speiser, Eva Drinka, Constantine Godellas, Claudia Perez, Alia Salhadar, Cagatay Ersahin, Jim Sinacore, Praba Rajan. Loyola University, Maywood, IL
Background: Lobular neoplasia (LN), defined as lobular carcinoma in situ (LCIS) and/or atypical lobular hyperplasia (ALH), has been traditionally recognized as a marker of increased risk for breast cancer development. However, the management of patients with LN identified on core biopsy is controversial. Although the recommendation is surgical excision, there have been studies suggesting that management in the form of “watchful waiting” along with radiological surveillance may be appropriate for this indolent lesion.
Design: A retrospective review of pathology database was performed to identify all cases of pure LN diagnosed by core biopsy (January 2000 – August 2010). Patient's age, family history, radiological findings (BIRADS), histopathological diagnosis at excision and follow-up status were noted. The rates of upgrade to a clinically significant lesion at surgical excision (ductal carcinoma in situ (DCIS) and infiltrating carcinoma) were recorded. Sensitivity, specificity and positive predictive value, as it relates to pathological and radiological findings, were calculated. Optimal data analysis was used to correlate imaging and excision biopsy findings.
Results: Thirty-one cases of lobular neoplasia detected on core biopsy were found, of which subsequent excision biopsy findings were available for 24 cases. The age ranged from 39 to 80 years (mean 44 years). Family history was present in 11/24 cases. All radiologically benign (BIRADS 2) findings were benign on excision biopsy. Histopathological diagnoses at excision were as follows: DCIS and infiltrating carcinoma (6/24, 25%), LN (12/24, 50%) and benign histology (6/24, 25%). Twenty-three out of 24 patients were alive and well until 2010; one patient died of cause unrelated to breast disease. Sensitivity, specificity and positive predictive value of radiological findings in detecting a significant lesion on excision were 100%, 75% and 100%, respectively. Optimal data analysis revealed a BIRADS 4 on imaging predicts the possibility of finding DCIS and/or infiltrating carcinoma on excision after core biopsy diagnosis of LN.
Conclusions: In this study, 25% of our patients with a core biopsy diagnosis of LN had co-existent DCIS or infiltrating carcinoma. All patients with a biologically significant lesion on excision had suspicious (BIRADS 4) imaging findings. Therefore, we recommend that clinical management for patients with a core biopsy diagnosis of LN should be assessed in a multidisciplinary setting involving the surgeon, radiologist and pathologist.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 14, Monday Morning