[130] Routine Excision Is Necessary for Lobular Neoplasia Detected on Breast Core Needle Biopsy: Experience from a Large Women's Health Center

Mohamed M Desouki, Anca V Florea, Khaled Mohammed, Xin Li, David Dabbs, Chengquan Zhao. UPMC, Pittsburgh, PA

Background: Lobular neoplasia (LN) is regarded as a risk indicator for the development of breast carcinoma. The significance of these lesions in core biopsy with respect to the need for surgical re-excision is controversial. The specific aim of this study was to ascertain pathologic findings of surgical follow-up excision (FUE) on patients who had LN on core biopsy.
Design: Core biopsies of breast from 2006-2011 with a diagnosis of LN with or without ADH, with no h/o invasive carcinoma (IC) or DCIS were studied. Cases were divided into: group 1 (pure LN) and group 2 (LN+ADH). Each group was further sub-divided into ALH or LCIS. Cases were considered to be upstaged if FUE showed IC or DCIS. Radiologic images, BIRADS and time between biopsy and FUE were recorded from the data files.
Results: 807 cases of LN were identified out of 20260 breast core biopsies (4%). 240 cases were excluded due to history or synchronous IC or DCIS (29.7%). Among the remaining 567 cases, 466 (82.2%) with FUE were included in the study. Patients were divided into groups as follow: ALH (235; 50%), LCIS (125; 27%), ALH+ADH (80; 17%) and LCIS+ADH (26; 6%). LN was confirmed by E-cad/P120 dual stain (263/466; 56.4%) or E-cad (70; 15%). The radiological abnormalities were calcification (78.5%), mass (14.2%) or other in 7.3%. The BI-RADS for group 1 were: score 4 in 256/260 (98.5% only 1 case score 5), and scores 3&5 in 4 cases (1.5%). For group 2, the BIRADS were: 4 in 78/80 (97.5%) and score 3 in 2 cases (2.5%) with no significant difference in relation to upstaging. The time interval between the core biopsy and FUE range from 0.3-7 month (mean 1.4) with significant difference in relation to upstaging in group 2. 28/360 (7.8%) and 17/106 (16.0%) of group 1 and group 2 cases upstaged to IC or DCIS (Table 1).

Table (1) Upstaging of LN on surgical follow-up excision
 ALH (%)LCIS (%)ALH+ADH (%)LCIS+ADH (%)Total (%)
IC5 (2.1)8 (6.4)6 (7.5)5 (19.2)24 (5.2)
DCIS8 (3.4)7 (5.6)3 (3.8)3 (11.5)21 (4.5)
ADH47 (20)25 (20)40 (50)7 (26.9)119 (25.5)
Not upstaged175 (74.5)85 (68)31 (38.7)11 (42.4)302 (64.8)
Chi square test, P=0.0001

Conclusions: 1. This is the largest study on patients with diagnosis of LN on core biopsy and FUE.
2. LN with or without ADH is a definite risk factor for upstaging to IC and/or DCIS.
3. The risk of upstaging on FUE for LCIS is more than that of ALH (15.2% vs. 7.0%) (p=0.0001).
4. Our data indicate that excision of the biopsy site is prudent for all patients with LN on core biopsy due to the significant percentage of cases which found to be upgraded to IC or DCIS.
Category: Breast

Monday, March 19, 2012 8:30 AM

Platform Session: Section B, Monday Morning


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