Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy

Miraj G. Shah-Khan, Xochiquetzal J. Geiger, Carol Reynolds, James W Jakub, Elizabeth R. DePeri, Katrina Nesta Glazebrook

Research output: Contribution to journalArticle

55 Citations (Scopus)

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 ipsilateralmalignancy 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 followup: 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.

Original languageEnglish (US)
Pages (from-to)3131-3138
Number of pages8
JournalAnnals of Surgical Oncology
Volume19
Issue number10
DOIs
StatePublished - Oct 2012

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Large-Core Needle Biopsy
Hyperplasia
Neoplasms
Lobular Carcinoma
Breast
Carcinoma, Intraductal, Noninfiltrating
Breast Carcinoma In Situ
Incidental Findings
Cohort Studies

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. / Shah-Khan, Miraj G.; Geiger, Xochiquetzal J.; Reynolds, Carol; Jakub, James W; DePeri, Elizabeth R.; Glazebrook, Katrina Nesta.

In: Annals of Surgical Oncology, Vol. 19, No. 10, 10.2012, p. 3131-3138.

Research output: Contribution to journalArticle

Shah-Khan, Miraj G. ; Geiger, Xochiquetzal J. ; Reynolds, Carol ; Jakub, James W ; DePeri, Elizabeth R. ; Glazebrook, Katrina Nesta. / Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 10. pp. 3131-3138.
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title = "Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy",
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 ipsilateralmalignancy 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 followup: 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.",
author = "Shah-Khan, {Miraj G.} and Geiger, {Xochiquetzal J.} and Carol Reynolds and Jakub, {James W} and DePeri, {Elizabeth R.} and Glazebrook, {Katrina Nesta}",
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T1 - Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy

AU - Shah-Khan, Miraj G.

AU - Geiger, Xochiquetzal J.

AU - Reynolds, Carol

AU - Jakub, James W

AU - DePeri, Elizabeth R.

AU - Glazebrook, Katrina Nesta

PY - 2012/10

Y1 - 2012/10

N2 - 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 ipsilateralmalignancy 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 followup: 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.

AB - 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 ipsilateralmalignancy 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 followup: 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.

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