Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2012

01-10-2012 | Breast Oncology

Long-Term Follow-up of Lobular Neoplasia (Atypical Lobular Hyperplasia/Lobular Carcinoma In Situ) Diagnosed on Core Needle Biopsy

Authors: Miraj G. Shah-Khan, MD, Xochiquetzal J. Geiger, MD, Carol Reynolds, MD, James W. Jakub, MD, Elizabeth R. DePeri, MD, Katrina N. Glazebrook, MB, ChB

Published in: Annals of Surgical Oncology | Issue 10/2012

Login to get access

Abstract

Background

Lobular neoplasia (LN) includes atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS). LN often is an incidental finding on breast core needle biopsy (CNBx) and management remains controversial. Our objective was to define the incidence of malignancy in women diagnosed with pure LN on CNBx, and identify a subset of patients that may be observed.

Methods

Patients diagnosed with LN on CNB between January 1993 and December 2010 were identified. Patients with an associated high-risk lesion or ipsilateral malignancy at time of diagnosis were excluded. All cases were reviewed by dedicated breast pathologists and breast imagers for pathologic classification and radiologic concordance, respectively.

Results

The study cohort was comprised of 184 (1.3 %) cases of pure LN (147 ALH, 37 LCIS) from 180 patients. Pathologic–radiologic concordance was achieved in 171 (93 %) cases. Excision was performed in 101 (55 %) cases and 83 (45 %) were observed. Mean follow-up was 50.3 (range, 6–212) months. Of cases excised, 1 of 81 (1.2 %) ALH and 1 of 20 (5 %) LCIS cases were upstaged to ductal carcinoma in situ (DCIS) and invasive lobular carcinoma (ILC), respectively. Only 1 of 101 (1 %) concordant lesions was upstaged on excision. Of the cases observed, 4 of 65 (6.2 %) developed ipsilateral cancer during follow-up: 1 of 51 (2 %) case of ALH and 3 of 14 (21.4 %) cases with LCIS (2 ILC, 2 DCIS). During follow-up, 2.9 % (4/138) patients with excised or observed LN developed a contralateral cancer.

Conclusions

These data support that not all patients with LN diagnosed on CNB require surgical excision. Patients with pure ALH, demonstrating radiologic–pathologic concordance, may be safely observed.
Literature
1.
Haagensen CD, Lane N, Lattes R, Bodian C. Lobular neoplasia (so-called lobular carcinoma in situ) of the breast. Cancer. 1978;42:737–69.PubMedCrossRef
2.
Chuba PJ, Hamre MR, Yap J, et al. Bilateral risk for subsequent breast cancer after lobular carcinoma-in-situ: analysis of surveillance, epidemiology, and end results data. J Clin Oncol. 2005;23:5534–41.PubMedCrossRef
3.
Bodian CA, Perzin KH, Lattes R. Lobular neoplasia. Long-term risk of breast cancer and relation to other factors. Cancer 1996;78:1024–34.PubMedCrossRef
4.
Simpson PT, Gale T, Fulford LG, et al. The diagnosis and management of pre-invasive breast disease: pathology of atypical lobular hyperplasia and lobular carcinoma in situ. Breast Cancer Res. 2003;5:258–62.PubMedCrossRef
5.
Page DL, Schuyler PA, Dupont WD, et al. Atypical lobular hyperplasia as a unilateral predictor of breast cancer risk: a retrospective cohort study. Lancet. 2003;361:125–9.PubMedCrossRef
6.
Dershaw DD. Does LCIS or ALH without other high-risk lesions diagnosed on core biopsy require surgical excision? Breast J. 2003;9:1–3.PubMedCrossRef
7.
Cited with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™) for Breast Cancer (V.1.2012) c 2012. National Comprehensive Cancer Network, Inc. All rights reserved. Available at: NCCN.org. Accessed 3/1/2012. The NCCN Guidelines™ herein may not be reproduced without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines, go on-line to NCCN.org.
8.
Li CI, Anderson BO, Daling JR, Moe RE. Changing incidence of lobular carcinoma in situ of the breast. Breast Cancer Res Treat. 2002;75:259–68.PubMedCrossRef
9.
Oppong BA, King TA. Recommendations for women with lobular carcinoma in situ (LCIS). Oncology (Williston Park). 2011;25:1051–56, 1058.
10.
Visscher DW, Hartmann LC. Lobular neoplasia: how to manage with partial understanding. Oncology (Williston Park). 2011;25:1066–8.
11.
Liberman L, Sama M, Susnik B, et al. Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings. AJR Am J Roentgenol. 1999;173:291–9.PubMed
12.
Berg WA, Mrose HE, Ioffe OB. Atypical lobular hyperplasia or lobular carcinoma in situ at core-needle breast biopsy. Radiology. 2001;218:503–9.PubMed
13.
Hussain M, Cunnick GH. Management of lobular carcinoma in-situ and atypical lobular hyperplasia of the breast—a review. Eur J Surg Oncol. 2011;37:279–89.PubMedCrossRef
14.
Philpotts LE, Shaheen NA, Jain KS, et al. Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology. 2000;216:831–7.PubMed
15.
Sapino A, Frigerio A, Peterse JL, et al. Mammographically detected in situ lobular carcinomas of the breast. Virchows Arch. 2000;436:421–30.PubMedCrossRef
16.
Georgian-Smith D, Lawton TJ. Calcifications of lobular carcinoma in situ of the breast: radiologic–pathologic correlation. AJR Am J Roentgenol. 2001;176:1255–9.PubMed
17.
Londero V, Zuiani C, Linda A, et al. Lobular neoplasia: core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features. Breast. 2008;17:623–30.PubMedCrossRef
18.
Arpino G, Laucirica R, Elledge RM. Premalignant and in situ breast disease: biology and clinical implications. Ann Intern Med. 2005;143:446–57.PubMed
19.
Nagi CS, O’Donnell JE, Tismenetsky M, et al. Lobular neoplasia on core needle biopsy does not require excision. Cancer. 2008;112:2152–8.PubMedCrossRef
20.
Hwang H, Barke LD, Mendelson EB, Susnik B. Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary. Mod Pathol. 2008;21:1208–16.PubMedCrossRef
21.
Cohen MA. Cancer upgrades at excisional biopsy after diagnosis of atypical lobular hyperplasia or lobular carcinoma in situ at core-needle biopsy: some reasons why. Radiology. 2004;231:617–21.PubMedCrossRef
22.
Elsheikh TM, Silverman JF. Follow-up surgical excision is indicated when breast core needle biopsies show atypical lobular hyperplasia or lobular carcinoma in situ: a correlative study of 33 patients with review of the literature. Am J Surg Pathol. 2005;29:534–43.PubMedCrossRef
23.
Brem RF, Lechner MC, Jackman RJ, et al. Lobular neoplasia at percutaneous breast biopsy: variables associated with carcinoma at surgical excision. AJR Am J Roentgenol. 2008;190:637–41.PubMedCrossRef
24.
Renshaw AA, Derhagopian RP, Martinez P, Gould EW. Lobular neoplasia in breast core needle biopsy specimens is associated with a low risk of ductal carcinoma in situ or invasive carcinoma on subsequent excision. Am J Clin Pathol. 2006;126:310–3.PubMedCrossRef
25.
Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med. 1985;312:146–51.PubMedCrossRef
26.
London SJ, Connolly JL, Schnitt SJ, Colditz GA. A prospective study of benign breast disease and the risk of breast cancer. JAMA. 1992;267:941–4.PubMedCrossRef
27.
Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005;353:229–37.PubMedCrossRef
28.
Page DL, Kidd TE Jr, Dupont WD, et al. Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol. 1991;22:1232–9.PubMedCrossRef
29.
Fisher ER, Land SR, Fisher B, et al. Pathologic findings from the National Surgical Adjuvant Breast and Bowel Project: twelve-year observations concerning lobular carcinoma in situ. Cancer. 2004;100:238–44.PubMedCrossRef
30.
Lakhani SR, Audretsch W, Cleton-Jensen AM, et al. The management of lobular carcinoma in situ (LCIS). Is LCIS the same as ductal carcinoma in situ (DCIS)? Eur J Cancer. 2006;42:2205–11.PubMedCrossRef
31.
King TA, Sakr RA, Muhsen S, et al. Is there a low-grade precursor pathway in breast cancer? Ann Surg Oncol. 2012;19:1115–21.PubMedCrossRef
32.
Hwang ES, Nyante SJ, Yi Chen Y, et al. Clonality of lobular carcinoma in situ and synchronous invasive lobular carcinoma. Cancer 2004;100:2562–72.PubMedCrossRef
33.
Mastracci TL, Shadeo A, Colby SM, et al. Genomic alterations in lobular neoplasia: a microarray comparative genomic hybridization signature for early neoplastic proliferation in the breast. Genes Chromosomes Cancer. 2006;45:1007–17.PubMedCrossRef
34.
De Leeuw WJ, Berx G, Vos CB, et al. Simultaneous loss of E-cadherin and catenins in invasive lobular breast cancer and lobular carcinoma in situ. J Pathol. 1997;183:404–11.PubMedCrossRef
35.
Esserman LE, Lamea L, Tanev S, Poppiti R. Should the extent of lobular neoplasia on core biopsy influence the decision for excision? Breast J. 2007;13:55–61.PubMedCrossRef
36.
Rendi MH, Dintzis SM, Lehman CD, et al. Lobular in-situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. Ann Surg Oncol. 2012;19:914–21.PubMedCrossRef
37.
Middleton LP, Grant S, Stephens T et al. Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised? Mod Pathol. 2003;16:120–9.PubMedCrossRef
38.
Mahoney MC, Robinson-Smith TM, Shaughnessy EA. Lobular neoplasia at 11-gauge vacuum-assisted stereotactic biopsy: correlation with surgical excisional biopsy and mammographic follow-up. AJR Am J Roentgenol. 2006;187:949–54.PubMedCrossRef
39.
Menon S, Porter GJ, Evans AJ, et al. The significance of lobular neoplasia on needle core biopsy of the breast. Virchows Arch. 2008;452:473–9.PubMedCrossRef
40.
Foster MC, Helvie MA, Gregory NE, et al. Lobular carcinoma in situ or atypical lobular hyperplasia at core-needle biopsy: is excisional biopsy necessary? Radiology. 2004;231:813–9.PubMedCrossRef
41.
Shin SJ, Rosen PP. Excisional biopsy should be performed if lobular carcinoma in situ is seen on needle core biopsy. Arch Pathol Lab Med. 2002;126:697–701.PubMed
42.
Crisi GM, Mandavilli S, Cronin E, Ricci A Jr. Invasive mammary carcinoma after immediate and short-term follow-up for lobular neoplasia on core biopsy. Am J Surg Pathol. 2003;27:325–33.PubMedCrossRef
43.
Cangiarella J, Guth A, Axelrod D, et al. Is surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy? A report of 38 cases and review of the literature. Arch Pathol Lab Med. 2008;132:979–83.PubMed
44.
Yeh IT, Dimitrov D, Otto P, et al. Pathologic review of atypical hyperplasia identified by image-guided breast needle core biopsy. Correlation with excision specimen. Arch Pathol Lab Med. 2003;127:49–54.PubMed
Metadata
Title
Long-Term Follow-up of Lobular Neoplasia (Atypical Lobular Hyperplasia/Lobular Carcinoma In Situ) Diagnosed on Core Needle Biopsy
Authors
Miraj G. Shah-Khan, MD
Xochiquetzal J. Geiger, MD
Carol Reynolds, MD
James W. Jakub, MD
Elizabeth R. DePeri, MD
Katrina N. Glazebrook, MB, ChB
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 10/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2534-9

Other articles of this Issue 10/2012

Annals of Surgical Oncology 10/2012 Go to the issue

Breast Oncology

Y-V Oncoplastic Wound Repair of Mastectomy Dog-Ear Deformity

Breast Oncology

Disease Recurrence in Sentinel Node-Positive Breast Cancer Patients Forgoing Axillary Lymph Node Dissection

Breast Oncology

Atypical Ductal Hyperplasia on Core Biopsy: An Automatic Trigger for Excisional Biopsy?

Breast Oncology

Editorial: Sentinel Node Biopsy for Breast Cancer: Past, Present, and Future

Breast Oncology

Patient Navigation and the Quality of Breast Cancer Care: An Analysis of the Breast Cancer Care Quality Indicators

Breast Oncology

Changing Behavior in Clinical Practice in Response to the ACOSOG Z0011 Trial: A Survey of the American Society of Breast Surgeons