Have an account? Please log in.
Text size: Small font Default font Larger font
.
Radiology Daily
Radiology Daily PracticalReviews.com Radiology Daily

All Lobular Neoplasias Should Be Excised

April 14, 2008
Written by: , Filed in: Breast Imaging
  • Comments
.

The objective of a recent study was to retrospectively review pathological results of lobular neoplasia to determine the underestimation rate and factors associated with underestimation.

The study has concluded that there is a significant underestimation rate of lobular neoplasia diagnosed at percutaneous biopsy and, therefore, subsequent surgical excisions are required.

Methodology
The study included retrospective data from 14 institutions; 278 cases were found to have lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) but no malignancy diagnosis. Underestimation rate and factors associated with underestimation rate were reviewed.

-----

Related CME

Women's Imaging
University of California San Francisco, Department of Radiology

  The overall goal of this program is to provide current information on the relevant use of imaging and interventional techniques in women with breast and gynecologic pathology. Core concepts and future directions are addressed, including cancer screening, breast intervention, and current status of breast and gynecologic MRI. Up to 20.75 AMA PRA Category 1 Credit(s)™ are available.
Read more or order: Women's Imaging

Imaging Review: Body, Bone & Breast
University of California, San Francisco, Department of Radiology
  This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging, as well as an up-to-date assessment of the clinical uses of modern imaging modalities such as CT, MR and ultrasound. 20 AMA PRA Category 1 Credit(s)™ are available.
  Read more or order: Imaging Review: Body, Bone & Breast

Results of the Study
278 lobular neoplasias represented 0.9% of total lesions biopsied during the review period. LCIS represented 36% and ALH represented 64% of total study cases. Of lobular neoplasia cases, 59% underwent surgical excision after percutaneous biopsies. At surgery, 25% of LCIS and 22% of ALH cases were upgraded to ductal carcinoma in situ or invasive carcinomas.

Statistically significant underestimation was associated with mass lesions rather than microcalcifications and with higher BIRADS category lesions. In addition, retrieving <10 specimens and using the core biopsy technique instead of the vacuum-assisted technique was associated with significant underestimation rates. Conclusions
There is a significant underestimation rate of lobular neoplasia diagnosed at percutaneous biopsy and, therefore, subsequent surgical excisions are required.

Reviewer’s Comments
Lobular neoplasia is an uncommon diagnosis but is an important entity. Lobular neoplasia includes LCIS and ALH, which are high-risk lesions for future malignancy. Current management recommendations for lobular neoplasia diagnosed at percutaneous biopsy includes surgical excision of all, surgical excision of selected cases, and close imaging and clinical surveillance without surgical intervention.

The authors of this article emphasized the importance of persistent sampling errors with all percutaneous biopsies. and need for subsequent surgical excision when lobular neoplasias are diagnosed at percutaneous biopsy of the breast.

Author: Bokran Won, MD

Reference
Brem RF, Lechner MC, et al: AJR; 2008; 190 (March): 637-641:
Lobular Neoplasia at Percutaneous Breast Biopsy: Variables Associated With Carcinoma at Surgical Excision.

-----

Related CME

Women's Imaging
University of California San Francisco, Department of Radiology

  The overall goal of this program is to provide current information on the relevant use of imaging and interventional techniques in women with breast and gynecologic pathology. Core concepts and future directions are addressed, including cancer screening, breast intervention, and current status of breast and gynecologic MRI. Up to 20.75 AMA PRA Category 1 Credit(s)™ are available.
Read more or order: Women's Imaging

Imaging Review: Body, Bone & Breast
University of California, San Francisco, Department of Radiology
  This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging, as well as an up-to-date assessment of the clinical uses of modern imaging modalities such as CT, MR and ultrasound. 20 AMA PRA Category 1 Credit(s)™ are available.
  Read more or order: Imaging Review: Body, Bone & Breast
.
  • Comments
.

Would you like to keep current with radiological news and information?

Post Your Comments and Responses

Comments are closed.