Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: Routine excision is not necessary

Helena Hwang, Lora D. Barke, Ellen B. Mendelson, Barbara Susnik

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Standardized recommendations for the management of lobular neoplasia in core biopsy specimens are not established. The aim of our study was to define morphologic features of lobular neoplasia in core biopsies that predict the finding of ductal carcinoma in situ or invasive carcinoma in the subsequent excisional specimen. We reviewed 333 cases of atypical lobular hyperplasia or lobular carcinoma in situ without ductal carcinoma in situ or invasive carcinoma diagnosed in core biopsies from 1996 to 2006. Subsequent excision was performed in 41% (136/333) of cases, including atypical lobular hyperplasia (n=48), lobular carcinoma in situ (n=39), and lobular neoplasia associated with atypical ductal hyperplasia (n=49). Upgrades were identified in 2% (1/48) of atypical lobular hyperplasia, 23% (9/39) of lobular carcinoma in situ, and 27% (13/49) of lobular neoplasia associated with atypical ductal hyperplasia cases. When further analyzed, the upgraded cases of lobular carcinoma in situ were associated with radiologic-pathologic discordance in 6/9 cases and with nonclassic pathology (two lobular carcinoma in situ with necrosis and one pleomorphic lobular carcinoma in situ) in the remaining three cases. The frequency of upgrade was 11% (3/26) in classic lobular carcinoma in situ, and 46% (6/13) in nonclassic types (pleomorphic or with necrosis). After excluding cases with discordant imaging/pathology, there was a 5% upgrade in our excisional specimens. After excluding cases where the upgrade was associated with nonclassic morphology, the upgrade in our study was 1%. Our results suggest that atypical lobular hyperplasia and classic lobular carcinoma in situ with concordant radiology and pathology can be appropriately managed with clinical follow-up without surgery.

Original languageEnglish (US)
Pages (from-to)1208-1216
Number of pages9
JournalModern Pathology
Volume21
Issue number10
DOIs
StatePublished - Oct 2008

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Hyperplasia
Biopsy
Carcinoma, Intraductal, Noninfiltrating
Pathology
Neoplasms
Necrosis
Carcinoma
Breast Carcinoma In Situ
Radiology

Keywords

  • Atypical lobular hyperplasia
  • Core biopsy
  • Lobular carcinoma in situ
  • Lobular neoplasia
  • Upgrade

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens : Routine excision is not necessary. / Hwang, Helena; Barke, Lora D.; Mendelson, Ellen B.; Susnik, Barbara.

In: Modern Pathology, Vol. 21, No. 10, 10.2008, p. 1208-1216.

Research output: Contribution to journalArticle

Hwang, Helena ; Barke, Lora D. ; Mendelson, Ellen B. ; Susnik, Barbara. / Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens : Routine excision is not necessary. In: Modern Pathology. 2008 ; Vol. 21, No. 10. pp. 1208-1216.
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abstract = "Standardized recommendations for the management of lobular neoplasia in core biopsy specimens are not established. The aim of our study was to define morphologic features of lobular neoplasia in core biopsies that predict the finding of ductal carcinoma in situ or invasive carcinoma in the subsequent excisional specimen. We reviewed 333 cases of atypical lobular hyperplasia or lobular carcinoma in situ without ductal carcinoma in situ or invasive carcinoma diagnosed in core biopsies from 1996 to 2006. Subsequent excision was performed in 41{\%} (136/333) of cases, including atypical lobular hyperplasia (n=48), lobular carcinoma in situ (n=39), and lobular neoplasia associated with atypical ductal hyperplasia (n=49). Upgrades were identified in 2{\%} (1/48) of atypical lobular hyperplasia, 23{\%} (9/39) of lobular carcinoma in situ, and 27{\%} (13/49) of lobular neoplasia associated with atypical ductal hyperplasia cases. When further analyzed, the upgraded cases of lobular carcinoma in situ were associated with radiologic-pathologic discordance in 6/9 cases and with nonclassic pathology (two lobular carcinoma in situ with necrosis and one pleomorphic lobular carcinoma in situ) in the remaining three cases. The frequency of upgrade was 11{\%} (3/26) in classic lobular carcinoma in situ, and 46{\%} (6/13) in nonclassic types (pleomorphic or with necrosis). After excluding cases with discordant imaging/pathology, there was a 5{\%} upgrade in our excisional specimens. After excluding cases where the upgrade was associated with nonclassic morphology, the upgrade in our study was 1{\%}. Our results suggest that atypical lobular hyperplasia and classic lobular carcinoma in situ with concordant radiology and pathology can be appropriately managed with clinical follow-up without surgery.",
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