Lobular Neoplasia on Core Needle Biopsy: Clinical and Radiopathologic Correlation Study with Follow-Up Excision Biopsy of 87 Cases
Shweta Chaudhary, Loretta Lawrence, Geraldine McGinty, Karen Kostroff, Rachel Robbins, Tawfiqul Bhuiya. North Shore LIJ Health System, Lake Success, NY; North Shore LIJ Health System, New Hyde Park, NY; Nassau Radiologic Group, Lake Success, NY
Background: Lobular neoplasia(LN) which includes Lobular carcinoma in situ (LCIS) and Atypical lobular hyperplasia (ALH) may be identified in breast core biopsies as an incidental finding with microcalcifications, mass lesion or indeterminate enhancements. Several studies have shown variable upgrade rates (1-40%), but many of these are limited by small sample size, selection bias and discordant radiopathologic correlation. The aim of our study was to assess the risk of invasive carcinoma/DCIS at the site of the isolated LN diagnosis on core biopsy and to assess any significant factors associated with the upgrade.
Design: The data base was searched for breast core biopsies from Jun 06- Jun 11 with the diagnosis of LCIS/ALH. Any case with coexistent pleomorphic LCIS, ADH, flat epithelial atypia, papilloma or radial scar was excluded from the study. Core and excision biopsy slides of all cases were reviewed using Page's criteria. Radiopathologic correlation was done for all cases. 87 cases with follow up excision biopsy qualified for study. Presence of invasive carcinoma/DCIS in direct correlation to initial biopsy site with LN defined the lesion as upgrade. The proportion of upgrade on excision and 95% confidence intervals (CI) were calculated.
Results: Our study consisted of 83 females, mean age 55 yrs (age range=37-88yrs) with 87 core biopsies showing isolated LN (22 ALH, 44 LCIS and 21 ALH&LCIS). Of these, 13 had family history and 28 had history of breast cancer (2 bilateral, 16 contralateral and 10 ipsilateral). Core biopsy indication included calcification in 36 (41%), non mass like enhancements in 17 (20%) and solid nodules or mass enhancement 34 (39%). 3/87 (3.4%) cases upgraded on excision biopsy. The upgraded lesions included low grade invasive ductal carcinoma (6mm), invasive lobular carcinoma (4mm) and pleomorphic LCIS with focal low grade DCIS. 2 of the upgraded cases were BIRADS 6 and 1 was BIRADS 4a. LCIS extent and associated microcalcifications showed no correlation with upgrade.
Conclusions: With a good sample size and radiopathologic correlation, our study showed a 3.4%(95%CI, 1-10%) upgrade on follow up excision for core biopsy with isolated LN. Our study essentially highlights benign outcome for isolated ALH/LCIS on core biopsy and gives a valid reason for rethinking the current practice of surgical excision for these patients.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 38, Monday Morning