Calhoun Benjamin C, Collie Angela M B, Lott-Limbach Abberly A, Udoji Esther N, Sieck Leah R, Booth Christine N, Downs-Kelly Erinn
Department of Pathology, Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH.
Ameripath Indiana, Indianapolis, IN.
Ann Diagn Pathol. 2016 Dec;25:20-25. doi: 10.1016/j.anndiagpath.2016.07.009. Epub 2016 Aug 18.
The appropriate follow-up and treatment for patients with a core biopsy diagnosis of lobular neoplasia (atypical lobular hyperplasia or lobular carcinoma in situ) remains controversial. Several studies have attempted to address this issue, with recommendations ranging from close clinical follow-up or surveillance to mandatory surgical excision in all cases. We report the findings at our institution, where virtually every core needle biopsy diagnosis of lobular neoplasia results in follow-up excision. The goal of the study was to identify potential predictors of upgrade to a more significant lesion. We identified 76 patients over a 15-year period with a core biopsy diagnosis of pure lobular neoplasia and no other high-risk lesions. Subsequent surgical excision identified 10 cases (13%) that were upgraded to carcinoma. Upgrade diagnoses included invasive ductal carcinoma (n=1), invasive lobular carcinoma (n=4), ductal carcinoma in situ (n=3), and pleomorphic lobular carcinoma in situ (n=2). All 10 upgraded cases had imaging findings suspicious for malignancy including irregular masses, asymmetric densities, or pleomorphic calcifications. Of the 10 upgraded cases, 7 were diagnosed as lobular carcinoma in situ on core biopsy. The data support a role for radiologic-pathologic correlation in the evaluation of suspicious breast lesions and suggest that the extent of lobular neoplasia in core biopsy specimens may be an indicator of the likelihood of upgrade to carcinoma.
对于经粗针活检诊断为小叶瘤变（非典型小叶增生或小叶原位癌）的患者，合适的后续随访及治疗仍存在争议。多项研究试图解决这一问题，建议范围从密切临床随访或监测到所有病例均需进行手术切除。我们报告了本机构的研究结果，实际上每例经粗针活检诊断为小叶瘤变的患者均接受了后续切除。本研究的目的是确定升级为更严重病变的潜在预测因素。我们在15年期间确定了76例经粗针活检诊断为单纯小叶瘤变且无其他高危病变的患者。随后的手术切除发现10例（13%）升级为癌。升级诊断包括浸润性导管癌（1例）、浸润性小叶癌（4例）、导管原位癌（3例）和多形性小叶原位癌（2例）。所有10例升级病例均有可疑恶性的影像学表现，包括不规则肿块、不对称密度或多形性钙化。在10例升级病例中，7例在粗针活检时被诊断为小叶原位癌。这些数据支持在评估可疑乳腺病变时进行放射学-病理学相关性分析，并且提示粗针活检标本中小叶瘤变的范围可能是升级为癌可能性的一个指标。
