Lobular neoplasia diagnosed on stereotactic core biopsy: a management conundrum?

Background

When breast core biopsy reveals lobular neoplasia (lobular carcinoma in situ [LCIS] or atypical lobular hyperplasia [ALH]) a management dilemma follows, as uncertainty regarding the significance of LCIS/ALH exists. Is this an indicator of increased risk of breast cancer or should it be considered a marker for more serious local pathology? Should surgical excision be undertaken in these cases?

Purpose

To correlate the finding of lobular neoplasia on stereotactic core biopsy with final histology and thus determine the appropriate management of such cases.

Method

The radiological and histological features of the cases of LCIS/ALH on stereotactic core biopsies since 1994 were reviewed and correlated with final histology.

Results

Ten cases of ALH and 12 cases of LCIS were found from a total of 2498 (0.01%) stereotactic core biopsies. Mammographic signs were distortion in two (9%), asymmetry in one (4%) and microcalcification in 19 (87%). Note was made of whether the microcalcification was in the area of LCIS/ALH, in benign tissue alone or in both. The LCIS was also classified histologically: classical, pleomorphic and solid ductal carcinoma in situ (DCIS) like.

Surgical histology was available in 20 cases with one case of invasive ductal carcinoma (5%), three invasive lobular carcinoma (15%), three DCIS alone (15%), and one of both invasive lobular carcinoma and DCIS (5%). The diagnosis was upgraded (from LCIS/ALH) in eight cases (40%)

Conclusion

We recommend surgical excision should be carried out when lobular neoplasia is diagnosed on the core biopsy. The benign breast biopsy rate should not be significantly affected, as these lesions are rare.