Findings on Excision Following a Core Needle Biopsy Diagnosis of Lobular Neoplasia: A Single Institution Experience
Abberly Lott Limbach, Angela Collie, Erinn Downs-Kelly. Cleveland Clinic, Cleveland, OH
Background: Controversy exists with regard to appropriate follow-up and treatment of patients with a core needle biopsy (CNB) diagnosis of lobular neoplasia; either atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS). There have been numerous published studies attempting to address this issue with conclusions ranging from only close clinical follow-up is needed to surgical excision should be performed in all cases. These studies are limited by small numbers of patients and differing inclusion criteria, making them difficult to compare. We assessed the findings at our institution, where virtually every CNB diagnosis of lobular neoplasia results in follow-up excision, to identify predictors of upgrade to a worse lesion.
Design: After obtaining institutional review board approval, we searched the anatomic pathology database for breast CNBs with subsequent surgical excisions between 1993 and 2011. Forty patients with pure lobular neoplasia (ALH or LCIS) on CNB with no other high-risk lesions were identified. CNB and surgical excision histology, as well as radiologic data, were reviewed to determine if there were characteristics that could predict a worse lesion on excision.
Results: We identified 40 CNB diagnoses of ALH/LCIS with subsequent surgical excision and identified 10 cases (25%) (4 ALH and 6 LCIS) that were upgraded to a worse lesion. Upgrade diagnoses included invasive ductal carcinoma (n=2), invasive lobular carcinoma (n=2), DCIS (n=5), and pleomorphic LCIS (n=1). All 10 cases that were upgraded had imaging findings highly suspicious for malignancy (BI-RADS 4), including masses or pleomorphic calcifications. In contrast, 30 cases (75%) where there was no worse lesion identified on surgical excision did not have similar suspicious imaging findings.
Conclusions: Similar to previous studies, we have shown a greater likelihood of upgrade from a core needle biopsy diagnosis of lobular neoplasia when a radiographic worrisome finding, either mass or pleomorphic calcifications, is present. This data reinforces the importance of radiologic-pathologic correlation of suspicious breast lesions and may better identify those lesions requiring surgical excision.
Monday, March 4, 2013 1:00 PM
Poster Session II # 41, Monday Afternoon