title: The radiological features, diagnosis and management of screen-detected lobular neoplasia of the breast: Findings from the Sloane Project.
abstract: OBJECTIVE
  To investigate the radiological features, diagnosis and management of screen-detected lobular neoplasia (LN) of the breast.
  
  
  METHODS
  392 women with pure LN alone were identified within the prospective UK cohort study of screen-detected non-invasive breast neoplasia (the Sloane Project). Demography, radiological features and diagnostic and therapeutic procedures were analysed.
  
  
  RESULTS
  Non-pleomorphic LN (369/392) was most frequently diagnosed among women aged 50-54 and in 53.5% was at the first screen. It occurred most commonly on the left (58.0%; p = 0.003), in the upper outer quadrant and confined to one site (single quadrant or retroareolar region). No bilateral cases were found. The predominant radiological feature was microcalcification (most commonly granular) which increased in frequency with increasing breast density. Casting microcalcification as a predominant feature had a significantly higher lesion size compared to granular and punctate patterns (p = 0.034). 326/369 (88.3%) women underwent surgery, including 17 who underwent >1 operation, six who had mastectomy and six who had axillary surgery. Two patients had radiotherapy and 15 had endocrine treatment. Pleomorphic lobular carcinoma in situ (23/392) presented as granular microcalcification in 12; four women had mastectomy and six had radiotherapy.
  
  
  CONCLUSIONS
  Screen-detected LN occurs in relatively young women and is predominantly non-pleomorphic and unilateral. It is typically associated with granular or punctate microcalcification in the left upper outer quadrant. Management, including surgical resection, is highly variable and requires evidence-based guideline development.
authors.affiliation: Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, M23 9LT, UK; Centre for Imaging Sciences, Institute of Population Health, University of Manchester, M13 9PT, UK. Electronic address: anthony.maxwell@manchester.ac.uk.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Maxwell
authors.affiliation: Screening Quality Assurance Service West Midlands, Public Health England, 1st Floor, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Clements
authors.affiliation: Institute of Oncology, Level 4 - Bexley Wing, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Dodwell
authors.affiliation: Centre for Oncology and Molecular Medicine, Division of Medical Sciences, University of Dundee, Level 6, Ninewells Hospital, Dundee DD1 9SY, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Evans
authors.affiliation: Department of Breast Surgery, Nuffield House, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
authors.forename: Adele
authors.initials: A
authors.lastname: Francis
authors.affiliation: Screening Quality Assurance Service West Midlands, Public Health England, 1st Floor, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Monuwar
authors.initials: M
authors.lastname: Hussain
authors.affiliation: Department of Medical Statistics, Education and Research Centre, University Hospital of South Manchester, M23 9LT, UK; Centre for Biostatistics, Institute of Population Health, University of Manchester, M13 9PT, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Morris
authors.affiliation: Research Oncology, Guy's Hospital, King's College, London SE1 9RT, UK.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Pinder
authors.affiliation: Research Oncology, Guy's Hospital, King's College, London SE1 9RT, UK.
authors.forename: Elinor J
authors.initials: EJ
authors.lastname: Sawyer
authors.affiliation: Department of Pathology, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA.
authors.forename: Alastair
authors.initials: A
authors.lastname: Thompson
mesh_terms: D000368:Aged; D001940:Breast / Q000000981:diagnostic imaging / Q000473:pathology; D000071960:Breast Carcinoma In Situ / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D011446:Prospective Studies; D000069584:Unilateral Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006113:United Kingdom
keywords: Atypical lobular hyperplasia; Breast cancer; Lobular carcinoma in situ; Lobular neoplasia; Mammography; Screening