title: Incidental minimal atypical lobular hyperplasia on core needle biopsy: correlation with findings on follow-up excision.
abstract: BACKGROUND
  Atypical lobular hyperplasia (ALH), often an incidental finding in breast core biopsies, is largely considered to be a risk factor for carcinoma rather than a direct precursor. However, management of ALH is controversial. We review our experience with incidental minimal ALH on core biopsy, and correlate with excision and follow-up results.
  
  
  METHODS
  We evaluated all cases of ALH on core biopsy from 1999 to 2009 from our institution, focusing on cases with < or =3 foci of ALH (minimal), paired excision, and no other lesion on the core biopsy that by itself would require excision. Cases with discordant clinical/radiologic impressions, suggesting that a suspicious lesion had been missed on biopsy, were excluded. Therefore, the excisions were performed because of the diagnosis of ALH.
  
  
  RESULTS
  Of 56 cases with ALH on biopsy and paired excision, 42 showed minimal ALH. On excision, 26 had residual ALH and 13 were benign. Three cases had other atypical lesions: lobular carcinoma in situ (2 cases) and mild atypical ductal hyperplasia separate from the biopsy site (1 case). On follow-up, only 1 patient developed subsequent ALH in the same breast. No other ipsilateral lesions were later diagnosed (mean follow-up 3.2 y).
  
  
  CONCLUSIONS
  No case with ALH on biopsy had a lesion on excision requiring further treatment, suggesting that these patients can be managed more conservatively. Furthermore, no patients were diagnosed with a higher grade lesion in the same breast on follow-up. We propose that, if there is close radiologic correlation and follow-up, minimal incidental ALH on core biopsy (< or =3 foci) does not require excision.
authors.affiliation: Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Andrea Proctor
authors.initials: AP
authors.lastname: Subhawong
authors.forename: Ty K
authors.initials: TK
authors.lastname: Subhawong
authors.forename: Nagi
authors.initials: N
authors.lastname: Khouri
authors.forename: Theodore
authors.initials: T
authors.lastname: Tsangaris
authors.forename: Hind
authors.initials: H
authors.lastname: Nassar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001941:Breast Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D001943:Breast Neoplasms / Q000150:complications / Q000453:epidemiology; D002278:Carcinoma in Situ / Q000150:complications / Q000453:epidemiology; D018270:Carcinoma, Ductal, Breast / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D006965:Hyperplasia; D033162:Incidental Findings; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery*