The clinical significance of lobular neoplasia on breast core biopsy

Rouzan G. Karabakhtsian, Ronald Johnson, Jules Sumkin, David J. Dabbs

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

A core biopsy diagnosis of atypical ductal epithelial hyperplasia is upstaged on follow-up excisional biopsy (FUEB) to in situ or invasive carcinoma in about 20% of cases, thus prompting a FUEB. In contrast, upstaging information for a core biopsy diagnosis of pure lobular neoplasia (LN), without mass lesions or other risk-associated lesions is less clear. In this retrospective study, we report the largest consecutive series of patients who had a breast core biopsy diagnosis of LN and a FUEB. Core needle breast biopsies with a diagnosis of LN were retrieved from our files for the period 1999 to 2005, yielding 110 patients. One hundred and one patients had a follow-up surgical excision. Cases of LN with coexisting high-risk lesions (n=9, 10%) were excluded from the study. Patients with associated mass lesions all had benign findings (n=15, 16%) and had no impact on the study results. The remaining 77 core biopsies had no masses or risk lesions and were mammographically Breast Imaging Reporting and Data System 4 (BIRADS) for microcalcifications. Overall, 8/77 (10%) of patients with a radiographic BIRADS 4 image with calcifications and a core biopsy diagnosis of LN on core biopsy were upstaged on FUEB to ductal carcinoma in situ or invasive carcinoma. The numbers upstaged from core biopsies were as follows: atypical lobular hyperplasia (ALH) 4/52 (8%), mixed ALH/lobular carcinoma in situ (LCIS) 1/9 (10%), and pure LCIS 3/16 (19%). A core biopsy of LCIS with neoplastic epithelial calcifications was nearly 3 times more likely to be upstaged on FUEB compared with ALH. We conclude that a finding of LN on breast core biopsy in a patient with a BIRADS 4 image and calcifications is associated with a risk of 8% to 19% of upstaging to a treatable disease on FUEB.

Original languageEnglish (US)
Pages (from-to)717-723
Number of pages7
JournalAmerican Journal of Surgical Pathology
Volume31
Issue number5
DOIs
StatePublished - May 2007
Externally publishedYes

Fingerprint

Breast
Biopsy
Neoplasms
Information Systems
Hyperplasia
Carcinoma, Intraductal, Noninfiltrating
Carcinoma
Large-Core Needle Biopsy
Calcinosis
Retrospective Studies

Keywords

  • Breast core biopsy
  • Calcifications
  • Lobular neoplasia
  • Upstaging

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

The clinical significance of lobular neoplasia on breast core biopsy. / Karabakhtsian, Rouzan G.; Johnson, Ronald; Sumkin, Jules; Dabbs, David J.

In: American Journal of Surgical Pathology, Vol. 31, No. 5, 05.2007, p. 717-723.

Research output: Contribution to journalArticle

Karabakhtsian, Rouzan G. ; Johnson, Ronald ; Sumkin, Jules ; Dabbs, David J. / The clinical significance of lobular neoplasia on breast core biopsy. In: American Journal of Surgical Pathology. 2007 ; Vol. 31, No. 5. pp. 717-723.
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