title: Core Breast Biopsies Showing Lobular Carcinoma In Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia.
abstract: OBJECTIVE
  The purpose of this article is to determine the upgrade rate to ductal carcinoma in situ (DCIS) or invasive carcinoma at excision at the same site after percutaneous breast biopsy findings of atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) using current imaging and strict pathologic criteria.
  
  
  METHODS
  From January 2006 through September 2013, 32,960 breast core biopsies were performed; 1084 (3.3%) core biopsies found ALH or classic LCIS. For 447 lesions in 433 women, this was the only high-risk lesion at that site, with no ipsilateral malignancy, and results of excision were available.
  
  
  RESULTS
  Among the 447 lesions, 22 (4.9%) were malignant at excision, including 10 invasive carcinomas (two grade 2 and eight grade 1; all node negative) and 12 DCIS. The upgrade rate of LCIS was 9.3% (10/108; 95% CI, 5.1-16.2%) and that of ALH was 3.5% (12/339; 95% CI, 2.0-6.1%; p = 0.02). After excluding five cases with radiologic-pathologic discordance and reclassifying one core from ALH to LCIS at review, the upgrade rate for LCIS remained higher (8.4%; 9/107; 95% CI, 4.5-15.2%) than that for ALH (2.4%; 8/335; 95% CI, 1.2-4.6%; p = 0.01).
  
  
  CONCLUSIONS
  Excision is recommended for LCIS on core biopsy because of its 8.4-9.3% upgrade rate. Excluding discordant cases, patients with other high-risk lesions or concurrent malignancy, the risk of upgrade of ALH was 2.4%. Surveillance at 6, 12, and 24 months can be performed in lieu of excision because a short delay in diagnosis of the few malignancies is not expected to cause harm.
authors.affiliation: 1 Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA.|2 Present address: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Unit 1350, Houston, TX 77030.
authors.forename: Lauren Q Chang
authors.initials: LQ
authors.lastname: Sen
authors.affiliation: 1 Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA.|3 Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Wendie A
authors.initials: WA
authors.lastname: Berg
authors.affiliation: 4 Department of Radiology, Yale University School of Medicine, New Haven, CT.
authors.forename: Regina J
authors.initials: RJ
authors.lastname: Hooley
authors.affiliation: 5 Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Gloria J
authors.initials: GJ
authors.lastname: Carter
authors.affiliation: 5 Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA.|6 Present address: Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Desouki
authors.affiliation: 1 Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA.|3 Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Jules H
authors.initials: JH
authors.lastname: Sumkin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology
keywords: atypical lobular hyperplasia; lobular carcinoma in situ; lobular neoplasia; radiologic-pathologic discordance