title: Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In-situ in Patients with Lobular Neoplasia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 020).
abstract: BACKGROUND
  Lobular neoplasia (LN) represents a spectrum of atypical proliferative lesions, including atypical lobular hyperplasia and lobular carcinoma-in-situ. The need for excision for LN found on core biopsy (CB) is controversial. We conducted a prospective multi-institutional trial (TBCRC 20) to determine the rate of upgrade to cancer after excision for pure LN on CB.
  
  
  METHODS
  Patients with a CB diagnosis of pure LN were prospectively identified and consented to excision. Cases with discordant imaging and those with additional lesions requiring excision were excluded. Upgrade rates to cancer were quantified on the basis of local and central pathology review. Confidence intervals and sample size were based on exact binomial calculations.
  
  
  RESULTS
  A total of 77 of 79 registered patients underwent excision (median age 51 years, range 27-82 years). Two cases (3%; 95% confidence interval 0.3-9) were upgraded to cancer (one tubular carcinoma, one ductal carcinoma-in-situ) at excision per local pathology. Central pathology review of 76 cases confirmed pure LN in the CB in all but two cases. In one case, the tubular carcinoma identified at excision was also found in the CB specimen, and in the other, LN was not identified, yielding an upgrade rate of one case (1%; 95% CI 0.01-7) by central pathology review.
  
  
  CONCLUSIONS
  In this prospective study of 77 patients with pure LN on CB, the upgrade rate was 3% by local pathology and 1% by central pathology review, demonstrating that routine excision is not indicated for patients with pure LN on CB and concordant imaging findings.
authors.affiliation: Dana-Farber/Harvard Cancer Center, Boston, MA, USA.|Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
authors.forename: Faina
authors.initials: F
authors.lastname: Nakhlis
authors.affiliation: Mount Auburn Hospital, Cambridge, MA, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Gilmore
authors.affiliation: Dana-Farber/Harvard Cancer Center, Boston, MA, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gelman
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.affiliation: Indiana University Cancer Center, Indianapolis, IN, USA.
authors.forename: Kandice
authors.initials: K
authors.lastname: Ludwig
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: E Shelley
authors.initials: ES
authors.lastname: Hwang
authors.affiliation: Georgetown University Cancer Center, Washington, DC, USA.
authors.forename: Shawna
authors.initials: S
authors.lastname: Willey
authors.affiliation: Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Clifford
authors.initials: C
authors.lastname: Hudis
authors.affiliation: Dana-Farber/Harvard Cancer Center, Boston, MA, USA.|Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
authors.forename: J Dirk
authors.initials: JD
authors.lastname: Iglehart
authors.affiliation: Dana-Farber/Harvard Cancer Center, Boston, MA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lawler
authors.affiliation: Dana-Farber/Harvard Cancer Center, Boston, MA, USA.
authors.forename: Nicole Y
authors.initials: NY
authors.lastname: Ryabin
authors.affiliation: Dana-Farber/Harvard Cancer Center, Boston, MA, USA.|Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Schnitt
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. tking7@partners.org.
authors.forename: Tari A
authors.initials: TA
authors.lastname: King
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology