Open AccessFactors Indicating Surgical Excision in Classical Type of Lobular Neoplasia of the Breast
Author(s) -
Constanze Elfgen,
Christoph Tausch,
AnnKatrin Rodewald,
Uwe Güth,
Christoph Rageth,
Vesna BjelicRadisic,
Markus Fleisch,
Claudia Kurtz,
Jesus Gonzalez Diaz,
Zsuzsanna Varga
Publication year - 2021
Publication title -
breast care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.767
H-Index - 30
eISSN - 1661-3805
pISSN - 1661-3791
DOI - 10.1159/000516609
Subject(s) - medicine , surgical excision , general surgery , surgery
Purpose: Classical type of lobular neoplasia (LN) encompassing both atypical lobular hyperplasia and classical lobular carcinoma in situ of the breast is a lesion with uncertain malignant potential and has been the topic of several studies with conflicting outcome results. The aim of our study was to clarify outcome-relevant factors and treatment options of classical LN. Methods: We performed a pathological re-evaluation of the preoperative biopsy specimens and a retrospective clinical and radiological data analysis of 160 patients with LN from the Breast Center Zurich. Open surgery was performed in 65 patients, vacuum-assisted biopsy (VAB) in 79 patients, and surveillance after breast core needle biopsy (CNB) in 16 patients. Results: The upgrade rate into ductal carcinoma in situ/invasive cancer was the highest in case of imaging/histology discordance (40%). If the number of foci in the biopsy specimen was ≥3, the upgrade rate in the consecutive surgical specimens was increased ( p = 0.01). The association of classical LN with histological microcalcification correlated with shortened disease-free survival ( p < 0.01), whereas other factors showed no impact on follow-up. Conclusions: Surveillance or subsequent VAB after CNB of LN is sufficient in most cases. Careful consideration of individual radiological and histological factors is required to identify patients with a high risk of upgrade into malignancy. In those cases, surgical excision is indicated.