title: Atypical lobular hyperplasia and lobular carcinoma in situ at core breast biopsy: use of careful radiologic-pathologic correlation to recommend excision or observation.
abstract: OBJECTIVE
  To assess the utility of precise radiologic and pathologic correlation for establishing imaging-histologic concordance or discordance as a method to limit the number of patients requiring surgical excision when atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) is diagnosed at core biopsy.
  
  
  METHODS
  This study was approved by the institutional review board, and the requirement to obtain informed consent was waived. The pathology database was searched from 2000 to 2010 for core biopsies yielding ALH or LCIS devoid of any additional lesion that independently necessitated excision. All cases had to have either subsequent surgical excision or a minimum of 2 years of imaging follow-up. This yielded 50 cases from 49 women aged 40-73 years (mean age, 59 years). The authors performed detailed radiologic-pathologic analysis while blinded to subsequent follow-up information, comparing all biopsy-related images with the histologic findings at core biopsy and then designating each core biopsy finding as concordant or discordant. Then, results of subsequent surgery or extended follow-up for each case were unblinded and compared with original concordant or discordant designations. Outcomes and confidence intervals (CIs) were calculated.
  
  
  RESULTS
  Of the 43 benign concordant core biopsy findings, none were upgraded at surgery (n = 38) or extended follow-up (n = 5) (95% CI: 0%, 8%). Of the seven discordant biopsy findings, two were upgraded to ductal carcinoma in situ at surgery (n = 5); none of the cases were upgraded at follow-up (n = 2).
  
  
  CONCLUSIONS
  When careful radiologic-pathologic correlation is performed and concordance is achieved, women with ALH or LCIS at core biopsy can be observed.
authors.affiliation: Departments of Pathology and Radiology, University of Virginia, 1215 Lee St, Office 3034, Charlottesville, VA 22908; Department of Radiology, Emory University, Atlanta, Ga.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Atkins
authors.forename: Michael A
authors.initials: MA
authors.lastname: Cohen
authors.forename: Brandi
authors.initials: B
authors.lastname: Nicholson
authors.forename: Sandra
authors.initials: S
authors.lastname: Rao
mesh_terms: D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
references.citation: Oncology (Williston Park). 1994 Feb;8(2):45-9; discussion 49, 53-4
references.pmid: 8167087
references.citation: AJR Am J Roentgenol. 1999 Aug;173(2):291-9
references.pmid: 10430122
references.citation: Mod Pathol. 2003 Feb;16(2):120-9
references.pmid: 12591964
references.citation: Am J Surg Pathol. 2003 Mar;27(3):325-33
references.pmid: 12604888
references.citation: Arch Pathol Lab Med. 2002 Jun;126(6):697-701
references.pmid: 12033958
references.citation: J Natl Compr Canc Netw. 2006 May;4(5):511-22
references.pmid: 16687097
references.citation: Am J Surg Pathol. 2007 May;31(5):717-23
references.pmid: 17460455
references.citation: Breast J. 2007 Jan-Feb;13(1):55-61
references.pmid: 17214794
references.citation: Lancet. 2003 Jan 11;361(9352):125-9
references.pmid: 12531579
references.citation: AJR Am J Roentgenol. 2008 Mar;190(3):637-41
references.pmid: 18287433
references.citation: Arch Pathol Lab Med. 2009 Jul;133(7):1116-20
references.pmid: 19642738
references.citation: Am J Clin Pathol. 2001 Mar;115(3):362-9
references.pmid: 11242792
references.citation: Am J Surg Pathol. 2010 Jun;34(6):822-8
references.pmid: 20431477
references.citation: Cancer. 2008 May 15;112(10):2152-8
references.pmid: 18348299
references.citation: Am J Surg Pathol. 2008 Nov;32(11):1721-6
references.pmid: 18769331
references.citation: Radiology. 2001 Feb;218(2):503-9
references.pmid: 11161169
references.citation: Radiology. 2004 Jun;231(3):617-21
references.pmid: 15163803
references.citation: Arch Pathol Lab Med. 2008 Jun;132(6):979-83
references.pmid: 18517282
references.citation: Eur J Cancer. 2006 Sep;42(14):2205-11
references.pmid: 16876991
references.citation: J Surg Res. 2007 Oct;142(2):275-80
references.pmid: 17662303
references.citation: Breast J. 2003 Jan-Feb;9(1):10-2
references.pmid: 12558664
references.citation: Ann Intern Med. 2005 Sep 20;143(6):446-57
references.pmid: 16172443
references.citation: Am J Surg. 2006 Oct;192(4):534-7
references.pmid: 16978969
references.citation: Am J Surg Pathol. 2005 Apr;29(4):534-43
references.pmid: 15767810
references.citation: Ann Diagn Pathol. 2010 Aug;14(4):251-5
references.pmid: 20637429
references.citation: Cancer. 2013 Mar 1;119(5):1073-9
references.pmid: 23132235
references.citation: Am J Surg. 2010 Mar;199(3):319-23; discussion 323
references.pmid: 20226903
references.citation: Ann Surg Oncol. 2012 Mar;19(3):914-21
references.pmid: 21861212
references.citation: Am J Clin Pathol. 2006 Aug;126(2):310-3
references.pmid: 16891208
references.citation: Ann Surg Oncol. 1994 Mar;1(2):141-6
references.pmid: 7834439
references.citation: Histopathology. 2010 Sep;57(3):472-8
references.pmid: 20727019
references.citation: Am J Clin Pathol. 2002 May;117(5):797-9
references.pmid: 12090431
references.citation: Radiology. 2004 Jun;231(3):813-9
references.pmid: 15105449
references.citation: Tumori. 2009 Jan-Feb;95(1):32-5
references.pmid: 19366053
references.citation: Clin Radiol. 2001 Mar;56(3):216-20
references.pmid: 11247699
references.citation: Mod Pathol. 2011 Sep;24(9):1198-206
references.pmid: 21602816
references.citation: AJR Am J Roentgenol. 2006 Oct;187(4):949-54
references.pmid: 16985141
references.citation: Breast J. 2002 Jul-Aug;8(4):230-3
references.pmid: 12100116
references.citation: Breast J. 2003 Jan-Feb;9(1):4-9
references.pmid: 12558663