Lobular neoplasia on core needle biopsy does not require excision

Area of Science:

• Oncology
• Pathology
• Radiology

Background:

• Lobular neoplasia (LN), including atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), is frequently found incidentally on breast biopsies.
• The necessity of surgical excision for LN, a known breast carcinoma risk factor, remains debated.

Purpose of the Study:

• To evaluate the clinical utility of excising lobular neoplasia (LN) diagnosed via core needle biopsy (CNB).
• To determine if conservative management with radiologic follow-up is adequate for LN cases meeting strict diagnostic criteria.

Main Methods:

• A retrospective review of 98 cases of LCIS and/or ALH diagnosed by CNB.
• Exclusion of cases with co-existing lesions requiring excision or those not meeting strict LN diagnostic criteria.
• Correlation of radiographic findings (calcifications, mass lesions) with histologic diagnoses.

Main Results:

• Of 91 biopsies for calcifications and 7 for mass lesions, 53 patients were managed with radiologic follow-up.
• 45 patients underwent excision, with 42 (93%) showing only LN on final pathology.
• No disease recurrence was observed in patients who underwent excision; follow-up ranged from 1 to 8 years.

Conclusions:

• Surgical excision of lobular neoplasia (LN) is not routinely necessary.
• Accurate diagnosis requires careful radiographic-pathologic correlation and adherence to strict histologic criteria.
• Close radiologic and clinical follow-up is an adequate management strategy for confirmed LN.