RM Global Health

Lobular neoplasia, a common incidental finding on core needle biopsy of the breast, does not mandate excision, according to a report in the May 15th issue of Cancer.

"In those patients where the lobular neoplasia is incidental to the clinical/radiologic findings, it can be safely followed with annual clinical and/or radiologic examinations," Dr. Chandandeep S. Nagi from Mount Sinai School of Medicine, New York told Reuters Health. "No excision is needed."

Dr. Nagi and colleagues reviewed their institution's pathology computer database and correlated radiographic and histologic findings in patients who underwent core needle biopsies.

Among 98 cases with purely incidental atypical lobular hyperplasia (ALH) and/or lobular carcinoma in situ (LCIS), the authors report, none was found to demonstrate clinical or radiologic evidence of malignancy in the breast from which the core needle biopsy was obtained.

Fifty-three patients were followed radiologically with no surgical excision.

Forty-five patients underwent surgical excision; 42 of these either had the same diagnosis on excision as on core needle biopsy, or the ALH diagnosis was modified to LCIS (in 3 cases).

All patients who did not undergo excision, and for whom follow-up data were available, were stable at a mean follow-up of 2.9 years (range, 1 to 8 years), the report indicates.

"In the absence of radiologic discrepancies and excluding lobular neoplasia with larger cells and proliferative activity, the classic forms of lobular neoplasia can be managed with clinical surveillance without the need for surgical intervention," the investigators conclude.

"Lobular neoplasia should be surgically excised if a radiologic-pathologic discordance exists (both in terms of the number and pattern of calcifications), if there is a second biologically aggressive lesion requiring surgical excision, or if the lobular proliferation demonstrates ductal features," they add.

Cancer 2008;112:2152-2158.


Reviewed by Ramaz Mitaishvili, MD