Risk for Upgrade to Malignancy After Breast Core Needle Biopsy Diagnosis of Lobular Neoplasia: A Systematic Review and Meta-Analysis |
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| Institution: | 1. Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington;2. Department of Surgery, University of Washington, Seattle, Washington;3. Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington;4. Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington;5. Department of Population Health Sciences and Department of Mathematics, Duke University, Durham, North Carolina;1. Chair, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York;2. Senior Vice President / Regional Executive Director, Northwell Health, Manhasset, New York;3. Siemens Medical Solutions USA, Inc, Malvern, Pennsylvania;4. Feinstein Institutes for Medical Research, Manhasset, New York;5. Visiting Scholar, Feinstein Institutes for Medical Research, Manhasset, New York;6. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York;7. Senior Vice President of Imaging Services, Northwell Health, Manhassset, New York;8. Harvey L. Neiman Health Policy Institute, Reston, Virginia;9. School of Economics, Georgia Institute of Technology, Atlanta, Georgia;10. Vice Chair of Research, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York;1. Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada;2. Department of Radiology, The University of Michigan, Ann Arbor, Michigan;1. Division Director and Chief of Service, Department of Radiology and Medical Imaging, Emory University, Atlanta, Georgia;2. Chairman, Department of Radiology at Lahey Hospital & Medical Center, Professor of Radiology, Tufts University Medical School;3. Chair of the ACR Informatics Commission;1. Sleepwalkers podcast, iHeartRadio, New York City, New York;2. Johns Hopkins Medicine, Department of Radiology and Radiological Science, Department of Oncology and Department of Surgery. He serves as Director of Diagnostic Imaging and Body CT at Johns Hopkins University School of Medicine, Baltimore, Maryland;3. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland;1. Wavemaker, New York, New York;2. Professor, Johns Hopkins Medicine, Department of Radiology and Radiological Science, Department of Oncology and Department of Surgery. He serves as Director of Diagnostic Imaging and Body CT at JohnsHopkins University School of Medicine, Baltimore, Maryland;3. Associate Professor The Russell H. Morgan, Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland |
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| Abstract: | PurposeLobular neoplasia (LN) detected on breast core needle biopsy is frequently managed with surgical excision because of concern for undersampled malignancy. The authors performed a systematic review and meta-analysis to estimate the risk for upgrade to malignancy in the setting of imaging-concordant classic LN diagnosed on core biopsy.MethodsPubMed and Embase were searched for original articles published from 1998 to 2020 that reported rates of upgrade to malignancy for classic LN, including atypical lobular hyperplasia (ALH) and classic lobular carcinoma in situ (LCIS). Two reviewers extracted study data and assessed the following quality criteria: exclusion of variant LCIS, exclusion of imaging-discordant lesions, and outcome reporting for ≥70% of lesions. For studies meeting all criteria, pooled risks for upgrade to any malignancy (invasive carcinoma or ductal carcinoma in situ) and invasive malignancy for all LN, ALH, and LCIS were estimated using random-effects models.ResultsFor 65 full-text articles included in the review, the risk for upgrade to any malignancy ranged from 0% to 45%. Among the 16 studies that met all quality criteria for the meta-analysis, pooled risks for upgrade to any malignancy were 3.1% (95% confidence interval CI], 1.8%-5.2%) for all LN, 2.5% (95% CI, 1.6%-3.9%) for ALH, and 5.8% (95% CI, 2.9%-11.3%) for LCIS. Risks for upgrade to invasive malignancy were 1.3% (95% CI, 0.7%-2.4%) for all LN, 0.4% (95% CI, 0.0%-4.2%) for ALH, and 3.5% (95% CI, 2.0%-5.9%) for LCIS.ConclusionsThe risk for upgrade to malignancy for LN found on breast biopsy is low. Imaging surveillance can likely be offered as an alternative to surgical management for LN, particularly for ALH. |
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| Keywords: | Lobular neoplasia lobular carcinoma in situ atypical lobular hyperplasia |
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