Core Breast Biopsies Showing Lobular Carcinoma In Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia.
OBJECTIVE
The purpose of this article is to determine the upgrade rate to ductal carcinoma in situ (DCIS) or invasive carcinoma at excision at the same site after percutaneous breast biopsy findings of atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) using current imaging and strict pathologic criteria.


MATERIALS AND METHODS
From January 2006 through September 2013, 32,960 breast core biopsies were performed; 1084 (3.3%) core biopsies found ALH or classic LCIS. For 447 lesions in 433 women, this was the only high-risk lesion at that site, with no ipsilateral malignancy, and results of excision were available.


RESULTS
Among the 447 lesions, 22 (4.9%) were malignant at excision, including 10 invasive carcinomas (two grade 2 and eight grade 1; all node negative) and 12 DCIS. The upgrade rate of LCIS was 9.3% (10/108; 95% CI, 5.1-16.2%) and that of ALH was 3.5% (12/339; 95% CI, 2.0-6.1%; p = 0.02). After excluding five cases with radiologic-pathologic discordance and reclassifying one core from ALH to LCIS at review, the upgrade rate for LCIS remained higher (8.4%; 9/107; 95% CI, 4.5-15.2%) than that for ALH (2.4%; 8/335; 95% CI, 1.2-4.6%; p = 0.01).


CONCLUSION
Excision is recommended for LCIS on core biopsy because of its 8.4-9.3% upgrade rate. Excluding discordant cases, patients with other high-risk lesions or concurrent malignancy, the risk of upgrade of ALH was 2.4%. Surveillance at 6, 12, and 24 months can be performed in lieu of excision because a short delay in diagnosis of the few malignancies is not expected to cause harm.
['Sen|Lauren Q Chang|LQ|', 'Berg|Wendie A|WA|', 'Hooley|Regina J|RJ|', 'Carter|Gloria J|GJ|', 'Desouki|Mohamed M|MM|', 'Sumkin|Jules H|JH|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D062005:Biopsy, Large-Core Needle D001943:Breast Neoplasms D002278:Carcinoma in Situ D018270:Carcinoma, Ductal, Breast D018275:Carcinoma, Lobular D005260:Female D006801:Humans D006965:Hyperplasia D008875:Middle Aged D009361:Neoplasm Invasiveness
lobular carcinoma in situ atypical lobular hyperplasia radiologic-pathologic discordance lobular neoplasia