Lobular Neoplasia in Breast Core Needle Biopsy Specimens Is Associated With a Low Risk of Ductal Carcinoma In Situ or Invasive Carcinoma on Subsequent Excision

Andrew A. Renshaw, MD; Robert P. Derhagopian, MD; Pilar Martinez, MD; Edwin W. Gould, MD

Disclosures

Am J Clin Pathol. 2006;126(2):310-313. 

In This Article

Results

A total of 467 women had LN diagnosed on core needle biopsy during the study period. The age of the women ranged from 31 to 96 years (median, 56 years). Of the cases, 116 (24.8%) were confirmed by a lack of E-cadherin staining.

Of the 467 women, 101 (21.6%) had IC (74) or DCIS (27) diagnosed concurrently. In addition, 2 (0.4%) patients had previous diagnoses of IC (1) or DCIS (1), and 17 (3.6%) had a diagnosis of IC (11) or DCIS (6) in the other breast at the time of the diagnosis of LN.

For 156 (42.6%) of 366 patients without a concurrent diagnosis of IC or DCIS in the same breast, subsequent tissue diagnoses were available. The results are summarized in Table 2 . The ages of the women ranged from 31 to 88 years (median, 55 years). The lesion was in the right breast in 94, the left breast in 60, and in both breasts in 2. Biopsies were performed for calcifications in 119 cases and for a mass lesion in 47. Of the LN lesions, 42 were confirmed with E-cadherin staining. Ten cases represented the pleomorphic variant of LCIS. The women had 127 excisions, 17 subsequent core needle biopsies, and 12 mastectomies. The excisions ranged from 2 to 13.5 cm (mean, 5.3 cm).

Of 60 cases of LN and ADH, follow-up revealed IC in 5 women (8%) and DCIS in 10 (17%) for a total of 25%. Of 4 women with LN and a mucocele-like lesion, none had IC or DCIS on follow-up. Of 92 women with LN alone, 7 (8%) had a subsequent diagnosis of IC (6) or DCIS (1) on follow-up. However, 2 cases (2%) were found in sites away from the biopsy site, 3 (3%) in subsequent excision specimens of the biopsy site, and 2 in women who had undergone previous excision of the biopsy site without finding IC or DCIS.

The needle biopsy and subsequent excisional biopsy specimens of the 3 women with DCIS and IC in the biopsy site were reviewed. In 1 case with DCIS alone in the excision, review of the initial core needle biopsy specimen revealed a small focus of larger atypical cells that were positive for E-cadherin. On review, this focus was interpreted alternatively as pleomorphic LCIS or ADH by different observers in the pathology department. The cells in this focus strongly resembled the cells in the DCIS in the subsequent excision. In the second case, the excision of the biopsy site was performed 8 months after the biopsy, consisted of a specimen 10 cm in diameter, and contained a 4-mm well-differentiated invasive ductal carcinoma. This focus was not seen in continuity with the scar of the biopsy site. In the final case, in the 6-cm subsequent excision, the biopsy site could be seen traversing right through the area of DCIS, but no DCIS could be found in the needle biopsy specimen itself. A separate 5-mm focus of well-differentiated invasive ductal carcinoma also was found in the excision. Again, this focus could not be seen in continuity with the biopsy site.

The rate of DCIS or IC in the excision of the biopsy site was significantly lower for LN alone (3%) than for LN with ADH (25%; P < .0001).

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