title: Surgical outcome of biopsy-proven lobular neoplasia: is there any difference between lobular carcinoma in situ and atypical lobular hyperplasia?
abstract: OBJECTIVE
  The aims of our study were to determine the frequency of malignancy after surgical excision of biopsy-proven lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) lesions, to assess any difference between pure LCIS and pure ALH lesions regarding their radiologic presentation and the malignancy upgrade rate after surgical excision, and to evaluate the outcome of lesions that were not excised surgically but were followed up.
  
  
  METHODS
  Radiologic and pathologic records of 14,435 imaging-guided needle biopsies of the breast performed between 2004 and 2008 in three different institutions were retrospectively reviewed. A total of 126 patients (0.9%) had biopsy-proven LCIS or ALH, or both, as the highest-risk lesion. Among the 126 patients, 89 (71%) continued to surgery, and 14 were followed up for more than 24 months. The Mantel-Haensel chi-square test was used for statistical analysis.
  
  
  RESULTS
  Cancer upgrade was documented in 17 of the 43 LCIS (40%), 11 of the 40 ALH (27%), and two of the six combined ALH and LCIS lesions (33%) surgically excised, for a total malignancy upgrade rate of 34% (30/89). Both LCIS and ALH lesions presented mammographically in most cases as microcalcifications (p = 0.078). None of the 14 patients followed up for a mean period of 51 months showed development of malignancy.
  
  
  CONCLUSIONS
  No statistically significant difference was found between mammographic presentation and postsurgical outcome of LCIS versus ALH lesions. Surgical excision of these lesions is recommended as long as no evident criteria are provided to differentiate those that might be associated with an underlying malignancy.
authors.affiliation: Department of Radiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ibrahim
authors.forename: Ali
authors.initials: A
authors.lastname: Bessissow
authors.forename: Lucie
authors.initials: L
authors.lastname: Lalonde
authors.forename: Benoit
authors.initials: B
authors.lastname: Mesurolle
authors.forename: Isabelle
authors.initials: I
authors.lastname: Trop
authors.forename: André
authors.initials: A
authors.lastname: Lisbona
authors.forename: Mona
authors.initials: M
authors.lastname: El-Khoury
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D008327:Mammography; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013238:Stereotaxic Techniques; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014618:Vacuum