title: Surgical Outcomes of Lobular Neoplasia Diagnosed in Core Biopsy: Prospective Study of 316 Cases.
abstract: Management recommendations for lobular neoplasia (LN) including lobular carcinoma-in-situ (LCIS) and atypical lobular hyperplasia (ALH) diagnosed in core biopsies (CB) are controversial. Our aim was to prospectively identify a subset of patients who do not require subsequent surgical excision (SE).
  
  
  
  All patients diagnosed with LN on CB were enrolled and referred for SE. Cases with coexistent ductal carcinoma-in-situ or invasive carcinoma were excluded. Cases with coexistent ductal atypia (LN-DA) and LCIS variants (LN-V) were separated from pure classic LN (LN-C). Dedicated breast pathologists and radiologists reviewed cases with careful imaging/pathology correlation.
  
  
  
  Of 13,772 total percutaneous breast CB procedures, 302 of 370 patients diagnosed with LN underwent SE. Upgrade to carcinoma was present in 3.5% (8/228) LN-C, 26.7% LN-V (4/15), and 28.3% LN-DA (15/53). Calcifications were the imaging target for 180 (79%) of 228 LN-C cases; 7 were associated with upgrade (3.9%). Upgrades were rare for mass lesions (1/32) and magnetic resonance imaging-targeted lesions (0/14). Upgrades were similar for ALH and LCIS (3.4% vs. 4.5%). During postsurgical follow-up (mean, 34.5 months), 6.5% LN-C patients developed carcinoma in either breast.
  
  
  
  Although LN with nonclassic morphology or with associated ductal atypia requires SE, this can be avoided in LN-C diagnosed on CB targeting calcifications when careful imaging/pathology correlation is applied. Until larger numbers are studied, excising LN-C diagnosed as masses or magnetic resonance imaging-detected lesions may be prudent. Regardless of their selection for surgical management, LN patients need close surveillance in view of their long-term risk of breast cancer.
authors.affiliation: Allina Health Laboratories, Hospital Pathology Associates HPA, Minneapolis, MN.
authors.forename: Barbara
authors.initials: B
authors.lastname: Susnik
authors.affiliation: Allina Health System, Piper Breast Center, Minneapolis, MN.
authors.forename: Deborah
authors.initials: D
authors.lastname: Day
authors.affiliation: Suburban Radiologic Consultants Ltd., Minneapolis, MN.
authors.forename: Ellen
authors.initials: E
authors.lastname: Abeln
authors.affiliation: Allina Health System, Piper Breast Center, Minneapolis, MN.
authors.forename: Tara
authors.initials: T
authors.lastname: Bowman
authors.affiliation: Allina Health System, Virginia Piper Cancer Institute, Minneapolis, MN.
authors.forename: Janet
authors.initials: J
authors.lastname: Krueger
authors.affiliation: Allina Health System, Virginia Piper Cancer Institute, Minneapolis, MN. Electronic address: karen.swenson2@allina.com.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Swenson
authors.affiliation: Allina Health System, Virginia Piper Cancer Institute, Minneapolis, MN.
authors.forename: Michaela L
authors.initials: ML
authors.lastname: Tsai
authors.affiliation: Allina Health System, United Hospital Piper Breast Center, St Paul, MN.
authors.forename: Margit L
authors.initials: ML
authors.lastname: Bretzke
authors.affiliation: Allina Health Laboratories, Hospital Pathology Associates HPA, Minneapolis, MN.
authors.forename: Tamera J
authors.initials: TJ
authors.lastname: Lillemoe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000473:pathology*; D000071960:Breast Carcinoma In Situ / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D011230:Precancerous Conditions / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Atypical lobular hyperplasia; Breast cancer; Imaging pathology correlation; Lobular carcinoma in situ; Upgrade