Factors Indicating Surgical Excision in Classical Type of Lobular Neoplasia of the Breast

Constanze Elfgen; Christoph Tausch; Ann-Katrin Rodewald; Uwe Güth; Christoph Rageth; Vesna Bjelic-Radisic; Markus Fleisch; Claudia Kurtz; Jesus Gonzalez Diaz; Zsuzsanna Varga

doi:10.1159/000516609

Factors Indicating Surgical Excision in Classical Type of Lobular Neoplasia of the Breast

Breast Care (Basel). 2022 Apr;17(2):121-128. doi: 10.1159/000516609. Epub 2021 Jul 7.

Authors

Constanze Elfgen^{1

2}, Christoph Tausch¹, Ann-Katrin Rodewald³, Uwe Güth^{1

4}, Christoph Rageth⁵, Vesna Bjelic-Radisic^{2

6}, Markus Fleisch^{2

6}, Claudia Kurtz⁷, Jesus Gonzalez Diaz⁸, Zsuzsanna Varga³

Affiliations

¹ Breast Center Zurich, Zurich, Switzerland.
² University of Witten-Herdecke, Witten, Germany.
³ Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland.
⁴ Faculty of Medicine, University of Basel, Basel, Switzerland.
⁵ Department of Gynecology and Obstetrics, Breast Center, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
⁶ Institute of Gynecology and Obstetrics, University Hospital Wuppertal, Wuppertal, Germany.
⁷ Department of Radiology and Nuclear Medicine, Kantonsspital Luzern, Lucerne, Switzerland.
⁸ Faculty of Medicine, University of Zurich, Zurich, Switzerland.

Abstract

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.

Keywords: Atypical lobular hyperplasia; B3 lesion; Core needle biopsy; High-risk lesion; Lobular carcinoma in situ; Lobular neoplasia; Vacuum-assisted biopsy.