The significance of lobular neoplasia on needle core biopsy of the breast |
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Authors: | S Menon G J R Porter A J Evans I O Ellis C W Elston Z Hodi A H S Lee |
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Institution: | (1) Department of Radiology, Nottingham University Hospital, City Hospital Campus, Nottingham, UK;(2) Department of Histopathology, Nottingham University Hospital, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK |
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Abstract: | The management of a core biopsy diagnosis of lobular neoplasia is controversial. Detailed radiological–pathological review
of 47 patients with cores showing classical lobular neoplasia was performed (patients with pleomorphic lobular carcinoma in
situ (LCIS) or associated risk lesions were considered separately). Immediate surgical excision in 25 patients showed invasive
carcinoma in 7, ductal carcinoma in situ (DCIS) in 1 and pleomorphic LCIS in 1; radiological–pathological review showed that
the core biopsy missed a mass in 5, missed calcification in 2 and that calcification appeared adequately sampled in 2. Nineteen
patients had follow-up of at least 2 years. Four patients developed malignancy at the site of the core biopsy (invasive carcinoma
in three, DCIS in one); one carcinoma was mammographically occult, one patient had dense original mammograms and two had calcifications
apparently adequately sampled by the core. In conclusion, most carcinomas identified at the site of core biopsy showing lobular
neoplasia were the result of the core missing the radiological lesion, emphasising the importance of multidisciplinary review
and investigation of any discordance. Some carcinomas were found after apparently adequate core biopsy, raising the question
of whether excision biopsy should be considered after all core biopsy diagnoses of lobular neoplasia. |
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Keywords: | Lobular neoplasia Atypical lobular neoplasia Lobular carcinoma in situ Pleomorphic lobular carcinoma in situ Needle biopsy Breast |
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