Long-Term Follow-up of Lobular Neoplasia (Atypical Lobular Hyperplasia/Lobular Carcinoma In Situ) Diagnosed on Core Needle Biopsy

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• 作者：Miraj G. Shah-Khan MD (1)
  Xochiquetzal J. Geiger MD (2)
  Carol Reynolds MD (3)
  James W. Jakub MD (1)
  Elizabeth R. DePeri MD (4)
  Katrina N. Glazebrook MB ; ChB (5)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2012
• 出版时间：October 2012
• 年：2012
• 卷：19
• 期：10
• 页码：3131-3138
• 全文大小：387KB
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• 作者单位：Miraj G. Shah-Khan MD (1)
  Xochiquetzal J. Geiger MD (2)
  Carol Reynolds MD (3)
  James W. Jakub MD (1)
  Elizabeth R. DePeri MD (4)
  Katrina N. Glazebrook MB, ChB (5)
  
  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA
  2. Department of Laboratory Medicine, Mayo Clinic, Jacksonville, FL, USA
  3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
  4. Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
  5. Department of Radiology, Mayo Clinic, Rochester, MN, USA
  

文摘

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 ipsilateral malignancy 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, 6-12) 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 follow-up: 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.