Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2012 Oct;19(10):3131-8. doi: 10.1245/s10434-012-2534-9. Epub 2012 Jul 31.
Lobular neoplasia (LN) includes atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS). LN often is an incidental finding on breast core needle biopsy (CNBx) and management remains controversial. Our objective was to define the incidence of malignancy in women diagnosed with pure LN on CNBx, and identify a subset of patients that may be observed.
Patients diagnosed with LN on CNB between January 1993 and December 2010 were identified. Patients with an associated high-risk lesion or ipsilateral malignancy at time of diagnosis were excluded. All cases were reviewed by dedicated breast pathologists and breast imagers for pathologic classification and radiologic concordance, respectively.
The study cohort was comprised of 184 (1.3 %) cases of pure LN (147 ALH, 37 LCIS) from 180 patients. Pathologic-radiologic concordance was achieved in 171 (93 %) cases. Excision was performed in 101 (55 %) cases and 83 (45 %) were observed. Mean follow-up was 50.3 (range, 6-212) months. Of cases excised, 1 of 81 (1.2 %) ALH and 1 of 20 (5 %) LCIS cases were upstaged to ductal carcinoma in situ (DCIS) and invasive lobular carcinoma (ILC), respectively. Only 1 of 101 (1 %) concordant lesions was upstaged on excision. Of the cases observed, 4 of 65 (6.2 %) developed ipsilateral cancer during follow-up: 1 of 51 (2 %) case of ALH and 3 of 14 (21.4 %) cases with LCIS (2 ILC, 2 DCIS). During follow-up, 2.9 % (4/138) patients with excised or observed LN developed a contralateral cancer.
These data support that not all patients with LN diagnosed on CNB require surgical excision. Patients with pure ALH, demonstrating radiologic-pathologic concordance, may be safely observed.
小叶肿瘤（LN）包括不典型小叶增生（ALH）和小叶原位癌（LCIS）。LN 通常是乳腺芯针活检（CNBx）的偶然发现，其处理仍存在争议。我们的目的是确定在 CNBx 上诊断为纯 LN 的女性中恶性肿瘤的发生率，并确定可能可以观察的患者亚组。
确定 1993 年 1 月至 2010 年 12 月期间在 CNB 上诊断为 LN 的患者。排除在诊断时伴有高危病变或同侧恶性肿瘤的患者。所有病例均由专门的乳腺病理学家和乳腺成像专家分别进行病理分类和放射学一致性评估。
研究队列由 180 例患者中的 184 例（1.3%）纯 LN（147 例 ALH，37 例 LCIS）组成。171 例（93%）病例达到病理-放射学一致性。101 例（55%）进行了切除，83 例（45%）进行了观察。平均随访时间为 50.3 个月（范围为 6-212 个月）。在切除的病例中，1 例 ALH（1.2%）和 1 例 LCIS（5%）分别升级为导管原位癌（DCIS）和浸润性小叶癌（ILC）。仅 1 例（1%）符合条件的病变在切除后升级。在观察的病例中，65 例中有 4 例（6.2%）在随访期间发生同侧癌症：51 例 ALH 中有 1 例（2%），14 例 LCIS 中有 3 例（21.4%），其中包括 2 例 ILC 和 2 例 DCIS。在随访期间，切除或观察到 LN 的 138 例患者中有 2.9%（4 例）发生对侧癌症。
这些数据支持并非所有在 CNB 上诊断为 LN 的患者都需要手术切除。表现出放射-病理一致性的纯 ALH 患者可以安全观察。
