Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy. Issue 5 (6th November 2012)

• Record Type: Journal Article
• Authors: Murray, Melissa P.; Luedtke, Chad; Liberman, Laura; Nehhozina, Tatjana; Akram, Muzaffar; Brogi, Edi
• Is Part Of: Cancer. Volume 119:Issue 5(2013)
• Page Start: 1073
• Page End: 1079
• Publication Date: 2012-11-06
• Subjects: Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.27841
• Languages: English
• ISSNs: 0008-543X

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>BACKGROUND:</title> <p>No consensus exists on the need to excise breast lesions that yield classic lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) (known together as classic lobular neoplasia [LN]) as the highest risk lesion at percutaneous core‐needle biopsy (CNB). Here, the authors report findings from 72 consecutive lesions with LN at CNB and prospective surgical excision (EXB).</p> </sec> <sec id="abs1-2" sec-type="section"> <title>METHODS:</title> <p>Lesions that yielded LN at CNB at the authors' center have been referred for EXB since June 2004, regardless of imaging‐histologic <italic>concordance</italic>. A lesion was "<italic>concordant</italic>" if histologic findings provided sufficient explanation for imaging. An upgrade consisted of ductal carcinoma in situ and/or invasive carcinoma at EXB. Statistical analysis, including 95% confidence intervals (CIs), was performed.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>RESULTS:</title> <p>Between June 2004 and May 2009, CNB of 85 consecutive lesions yielded LN without other high‐risk histologies. Eighty of 85 lesions (94%) underwent prospective EXB. Seventy‐two of 85 lesions (90%; 42 LCIS, 30 ALH) had <italic>concordant</italic> imaging‐histologic findings. EXB yielded low‐grade carcinoma in 2 of 72 cases (3%; 95% CI, 0%‐9%). In both patients, stereotactic, 11‐gauge, vacuum‐assisted biopsy of calcifications yielded calcifications in benign parenchyma and ALH. CNB results were <italic>discordant</italic> in 8 of 80 lesions (10%; 4 LCIS, 4 ALH), and EXB yielded cancer in 3 of those 8 lesions (38%; 95% CI, 9%‐76%). The upgrade rate was significantly higher for <italic>discordant</italic> lesions versus <italic>concordant</italic> lesions (38% vs 3%; <italic>P</italic> < .01).</p> </sec> <sec id="abs1-4" sec-type="section"> <title>CONCLUSIONS:</title> <p>Prospective excision of LN identified carcinoma in 3% (95% CI, 0%‐9%) of <italic>concordant</italic> cases versus 38% (95% CI, 9%‐76%) of <italic>discordant</italic> cases. The current data provide an unbiased assessment of the upgrade rate of LN diagnosed at CNB. Cancer 2013. © 2012 American Cancer Society.</p> </sec> </abstract>