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Lobular neoplasia: is surgical excision warranted?
Vance Y Sohn1, Zachary M Arthurs, Flora S Kim
1Department of Surgery, Madigan Army Medical Center, Tacoma, Washington, USA. vance.sohn@us.army.mil
The American Surgeon
|March 1, 2008
Summary
Core needle biopsy (CNB) diagnosis of lobular neoplasia in breast tissue does not always require immediate surgery. Lobular neoplasia on CNB should be viewed as a risk marker, not an indication for routine open biopsy.
Area of Science:
- Oncology
- Pathology
- Radiology
Background:
- The management of lobular neoplasia detected via core needle biopsy (CNB) for breast cancer is debated.
- Accurate pathological assessment of CNB specimens is crucial for guiding treatment decisions.
Purpose of the Study:
- To determine the prevalence of lobular neoplasia in CNB specimens.
- To correlate CNB findings with final surgical pathology.
- To evaluate the risk of malignancy following lobular neoplasia diagnosis on CNB.
Main Methods:
- Retrospective review of patients diagnosed with lobular neoplasia on CNB.
- Exclusion of patients with concomitant malignant or atypical lesions.
- Analysis of diagnostic methods, clinical history, pathology results, and follow-up data.
Main Results:
- Of 50 patients with lobular neoplasia on CNB, 84% had atypical lobular hyperplasia and 16% had lobular carcinoma in situ.
- No malignancies were found in 21 patients undergoing immediate surgical excision.
- Four patients (8%) developed malignancies during follow-up, with 75% occurring in the ipsilateral breast.
Conclusions:
- Routine open surgical biopsy is not recommended for patients diagnosed with lobular neoplasia on CNB.
- Lobular neoplasia detected by CNB should be considered a risk factor for future invasive breast cancer.
- Serial follow-up may be appropriate for select patients.
