Is excisional biopsy indicated for patients with lobular neoplasia diagnosed on percutaneous core needle biopsy of the breast?

Background: The value of excisional biopsy for patients with lobular neoplasia diagnosed by core needle breast biopsy is controversial. Methods: A retrospective analysis of all patients with lobular carcinoma in situ or atypical lobular hyperplasia on core needle biopsy. Results: Twenty-five patients were identified. Twelve (48%) underwent excisional biopsy. None of the patients who had excisional biopsy were found to have ductal carcinoma in situ (DCIS) or invasive cancer. The mean follow-up was 66 months. Five patients (20%) developed DCIS or invasive cancer during follow-up. The rate of subsequent carcinoma among those undergoing excisional biopsy was 25%, and among those not undergoing excisional biopsy it was 15% (P = .57). Among patients who did not undergo excisional biopsy, none developed carcinoma within the same quadrant of the breast. Conclusions: Excisional biopsy for lobular neoplasia did not identify understaged carcinoma or alter the rate of subsequent carcinoma. The subsequent carcinoma risk is diffuse and bilateral; it does not correlate with the site at which lobular neoplasia was diagnosed.