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 3/2016

01-03-2016 | Breast Oncology

Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In-situ in Patients with Lobular Neoplasia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 020)

Authors: Faina Nakhlis, MD, Lauren Gilmore, MD, Rebecca Gelman, PhD, Isabelle Bedrosian, MD, Kandice Ludwig, MD, E. Shelley Hwang, MD, Shawna Willey, MD, Clifford Hudis, MD, J. Dirk Iglehart, MD, Elizabeth Lawler, BA, Nicole Y. Ryabin, BS, Mehra Golshan, MD, Stuart J. Schnitt, MD, Tari A. King, MD

Published in: Annals of Surgical Oncology | Issue 3/2016

Login to get access

Abstract

Background

Lobular neoplasia (LN) represents a spectrum of atypical proliferative lesions, including atypical lobular hyperplasia and lobular carcinoma-in-situ. The need for excision for LN found on core biopsy (CB) is controversial. We conducted a prospective multi-institutional trial (TBCRC 20) to determine the rate of upgrade to cancer after excision for pure LN on CB.

Methods

Patients with a CB diagnosis of pure LN were prospectively identified and consented to excision. Cases with discordant imaging and those with additional lesions requiring excision were excluded. Upgrade rates to cancer were quantified on the basis of local and central pathology review. Confidence intervals and sample size were based on exact binomial calculations.

Results

A total of 77 of 79 registered patients underwent excision (median age 51 years, range 27–82 years). Two cases (3 %; 95 % confidence interval 0.3–9) were upgraded to cancer (one tubular carcinoma, one ductal carcinoma-in-situ) at excision per local pathology. Central pathology review of 76 cases confirmed pure LN in the CB in all but two cases. In one case, the tubular carcinoma identified at excision was also found in the CB specimen, and in the other, LN was not identified, yielding an upgrade rate of one case (1 %; 95 % CI 0.01–7) by central pathology review.

Conclusions

In this prospective study of 77 patients with pure LN on CB, the upgrade rate was 3 % by local pathology and 1 % by central pathology review, demonstrating that routine excision is not indicated for patients with pure LN on CB and concordant imaging findings.
Literature
1.
Foote FW, Stewart FW. Lobular carcinoma in situ: a rare form of mammary cancer. Am J Pathol. 1941;17:491PubMed
2.
Fisher ER, Land SR, Fisher B, Mamounas E, Gilarski L, Wolmark N. Pathologic findings from the National Surgical Adjuvant Breast and Bowel Project: twelve-year observations concerning lobular carcinoma in situ. Cancer. 2004;100:238–44.CrossRefPubMed
3.
Hoda SA (2001) Lobular carcinoma in situ and atypical lobular hyperplasia. In: Rosen PP, editor Rosen’s breast pathology, 2nd ed. Lippincott Williams & Wilkins, Philiadelphia, PA, pp. 581–618.
4.
Rosen PP, Kosloff C, Lieberman PH, Adair F, Braun DW Jr. Lobular carcinoma in situ of the breast. Detailed analysis of 99 patients with average follow-up of 24 years. Am J Surg Pathol. 1978;2:225–51.CrossRefPubMed
5.
Beute BJ, Kalisher L, Hutter RV. Lobular carcinoma in situ of the breast: clinical, pathologic, and mammographic features. AJR Am J Roentgenol. 1991;157:257–65.CrossRefPubMed
6.
Bauer VP, Ditkoff BA, Schnabel F, Brenin D, El-Tamer M, Smith S. The management of lobular neoplasia identified on percutaneous core breast biopsy. Breast J. 2003;9:4–9.CrossRefPubMed
7.
Foster MC, Helvie MA, Gregory NE, Rebner M, Nees AV, Paramagul C. Lobular carcinoma in situ or atypical lobular hyperplasia at core-needle biopsy: is excisional biopsy necessary? Radiology. 2004;231:813–9.CrossRefPubMed
8.
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.CrossRefPubMed
9.
O’Driscoll D, Britton P, Bobrow L, Wishart GC, Sinnatamby R, Warren R. Lobular carcinoma in situ on core biopsy—what is the clinical significance? Clin Radiol. 2001;56:216–20.CrossRefPubMed
10.
Londero V, Zuiani C, Linda A, Vianello E, Furlan A, Bazzocchi M. Lobular neoplasia: core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features. Breast. 2008;17:623–30.CrossRefPubMed
11.
Renshaw AA, Cartagena N, Derhagopian RP, Gould EW. Lobular neoplasia in breast core needle biopsy specimens is not associated with an increased risk of ductal carcinoma in situ or invasive carcinoma. Am J Clin Pathol. 2002;117:797–9.CrossRefPubMed
12.
Dmytrasz K, Tartter PI, Mizrachy H, Chinitz L, Rosenbaum Smith S, Estabrook A. The significance of atypical lobular hyperplasia at percutaneous breast biopsy. Breast J. 2003;9:10–2.CrossRefPubMed
13.
Middleton LP, Grant S, Stephens T, Stelling CB, Sneige N, Sahin AA. Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised? Mod Pathol. 2003;16:120–9.CrossRefPubMed
14.
Arpino G, Allred DC, Mohsin SK, Weiss HL, Conrow D, Elledge RM. Lobular neoplasia on core-needle biopsy—clinical significance. Cancer. 2004;101:242–50.CrossRefPubMed
15.
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.CrossRefPubMed
16.
Irfan K, Brem RF. Surgical and mammographic follow-up of papillary lesions and atypical lobular hyperplasia diagnosed with stereotactic vacuum-assisted biopsy. Breast J. 2002;8:230–3.CrossRefPubMed
17.
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(6):697−701PubMed
18.
Yeh IT, Dimitrov D, Otto P, Miller AR, Kahlenberg MS, Cruz A. 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
19.
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.CrossRefPubMed
20.
Bonnett M, Wallis T, Rossmann M, et al. Histopathologic analysis of atypical lesions in image-guided core breast biopsies. Mod Pathol. 2003;16:154–60.CrossRefPubMed
21.
El-Sheikh 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.CrossRef
22.
Gradishar WJ, Anderson BO, Balassanian R, et al. Breast cancer, version 2.2015. J Natl Compr Canc Netw. 2015;13:448–75.PubMed
23.
Atkins KA, Cohen MA, Nicholson B, Rao S. Atypical lobular hyperplasia and lobular carcinoma in situ at core breast biopsy: use of careful radiologic-pathologic correlation to recommend excision or observation. Radiology. 2013;269:340–7.CrossRefPubMed
24.
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
25.
Chaudhary S, Lawrence L, McGinty G, Kostroff K, Bhuiya T. Classic lobular neoplasia on core biopsy: a clinical and radio-pathologic correlation study with follow-up excision biopsy. Mod Pathol. 2013;26:762–71.CrossRefPubMed
26.
Lewis JL, Lee DY, Tartter PI. The significance of lobular carcinoma in situ and atypical lobular hyperplasia of the breast. Ann Surg Oncol. 2012;19:4124–8.CrossRefPubMed
27.
Nagi CS, O’Donnell JE, Tismenetsky M, Bleiweiss IJ, Jaffer SM. Lobular neoplasia on core needle biopsy does not require excision. Cancer. 2008;112:2152–8.CrossRefPubMed
28.
Niell B, Specht M, Gerade B, Rafferty E. Is excisional biopsy required after a breast core biopsy yields lobular neoplasia? AJR Am J Roentgenol. 2012;199:929–35.CrossRefPubMed
29.
Rendi MH, Dintzis SM, Lehman CD, Calhoun KE, Allison KH. 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.CrossRefPubMed
30.
Shah-Khan MG, Geiger XJ, Reynolds C, Jakub JW, Deperi ER, Glazebrook KN. Longterm follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. Ann Surg Oncol. 2012;19:3131–8.CrossRefPubMed
31.
Zhao C, Desouki MM, Florea A, Mohammed K, Li X, Dabbs D. Pathologic findings of follow-up surgical excision for lobular neoplasia on breast core biopsy performed for calcification. Am J Clin Pathol. 2012;138:72–8.CrossRefPubMed
32.
Murray MP, Luedtke C, Liberman L, Nehhozina T, Akram M, Brogi E. Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: outcomes of prospective excision. Cancer. 2013;119:1073–9.CrossRefPubMed
33.
Gomes DS, Porto SS, Balabram D, Gobbi H. Inter-observer variability between general pathologists and a specialist in breast pathology in the diagnosis of lobular neoplasia, columnar cell lesions, atypical ductal hyperplasia and ductal carcinoma in situ of the breast. Diagn Pathol. 2014;9:121.PubMedCentralCrossRefPubMed
34.
Coopey SB, Mazzola E, Buckley JM, et al. The role of chemoprevention in modifying the risk of breast cancer in women with atypical breast lesions. Breast Cancer Res Treat. 2012;136:627–33.CrossRefPubMed
35.
Barr RG, Zhang Z, Cormack JB, Mendelson EB, Berg WA. Probably benign lesions at screening breast US in a population with elevated risk: prevalence and rate of malignancy in the ACRIN 6666 trial. Radiology. 2013;269:701–12.PubMedCentralCrossRefPubMed
Metadata
Title
Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In-situ in Patients with Lobular Neoplasia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 020)
Authors
Faina Nakhlis, MD
Lauren Gilmore, MD
Rebecca Gelman, PhD
Isabelle Bedrosian, MD
Kandice Ludwig, MD
E. Shelley Hwang, MD
Shawna Willey, MD
Clifford Hudis, MD
J. Dirk Iglehart, MD
Elizabeth Lawler, BA
Nicole Y. Ryabin, BS
Mehra Golshan, MD
Stuart J. Schnitt, MD
Tari A. King, MD
Publication date
01-03-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4922-4

Other articles of this Issue 3/2016

Annals of Surgical Oncology 3/2016 Go to the issue

Gynecologic Oncology

Predictive Modeling: A New Paradigm for Managing Endometrial Cancer

Colorectal Cancer

A Novel Immune Marker Model Predicts Oncological Outcomes of Patients with Colorectal Cancer

Gastrointestinal Oncology

Laparoscopic Infrapyloric Area Lymph Node Dissection with No. 14v Enlargement for Advanced Lower Gastric Cancer in Middle Colic Vein Approach

Gynecologic Oncology

Tumor Characteristics and Survival Outcome of Endometrial Cancer Arising in Adenomyosis: An Exploratory Analysis

Colorectal Cancer

Mutation Spectra of Common Cancer-Associated Genes in Different Phenotypes of Colorectal Carcinoma Without Distant Metastasis

Breast Oncology

Reoperative Sentinel Lymph Node Biopsy is Feasible for Locally Recurrent Breast Cancer, But is it Worthwhile?