How Do We Approach Benign Proliferative Lesions?

Overview

Journal Curr Oncol Rep

Publisher Current Science

Specialty Oncology

Date 2018 Mar 25

PMID 29572753

Citations 5

Authors

Faina Nakhlis

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: The aim of this review is to summarize recently published literature addressing atypical ductal hyperplasia (ADH), lobular neoplasia (atypical lobular hyperplasia [ALH] and classic lobular carcinoma in situ [C-LCIS]), non-classic lobular carcinoma in situ (NC-LCIS), papillary lesions, and flat epithelial atypia (FEA).

Recent Findings: While ADH, ALN, and C-LCIS are well-established markers of an increased risk of future breast cancers, the risk implications are less clear for papillary lesions and FEA. NC-LCIS is the least well-characterized lesion, with scant published literature on its natural history and surgical management when encountered on needle biopsy. Recent data suggest that lobular neoplasia on core biopsy of a BI-RADS ≤ 4 concordant lesion does not require an excision, while ADH, atypical papillomas, and NC-LCIS should be excised. Evidence on FEA and papillomas without atypia suggests a low risk of upgrade on excision, and prospective studies on the upgrade of these lesions are ongoing.

Citing Articles

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References

Kohr J, Eby P, Allison K, DeMartini W, Gutierrez R, Peacock S . Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. Radiology. 2010; 255(3):723-30. DOI: 10.1148/radiol.09091406. View

Liberman L, Sama M, Susnik B, Rosen P, LaTrenta L, Morris E . Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings. AJR Am J Roentgenol. 1999; 173(2):291-9. DOI: 10.2214/ajr.173.2.10430122. View

Dmytrasz K, Tartter P, Mizrachy H, Chinitz L, Smith S, Estabrook A . The significance of atypical lobular hyperplasia at percutaneous breast biopsy. Breast J. 2003; 9(1):10-2. DOI: 10.1046/j.1524-4741.2003.09103.x. View

Dialani V, Venkataraman S, Frieling G, Schnitt S, Mehta T . Does isolated flat epithelial atypia on vacuum-assisted breast core biopsy require surgical excision?. Breast J. 2014; 20(6):606-14. DOI: 10.1111/tbj.12332. View

Mosier A, Keylock J, Smith D . Benign papillomas diagnosed on large-gauge vacuum-assisted core needle biopsy which span <1.5 cm do not need surgical excision. Breast J. 2013; 19(6):611-7. DOI: 10.1111/tbj.12180. View

Nakhlis F, Gilmore L, Gelman R, Bedrosian I, Ludwig K, Hwang E . Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In-situ in Patients with Lobular Neoplasia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 020). Ann Surg Oncol. 2015; 23(3):722-8. PMC: 4984674. DOI: 10.1245/s10434-015-4922-4. View

Polat A, Soran A, Kanbour-Shakir A, Menekse E, Balci F, Johnson R . The role of molecular biomarkers for predicting adjacent breast cancer of Atypical Ductal Hyperplasia diagnosed on core biopsy. Cancer Biomark. 2016; 17(3):293-300. DOI: 10.3233/CBM-160641. View

King T, Pilewskie M, Muhsen S, Patil S, Mautner S, Park A . Lobular Carcinoma in Situ: A 29-Year Longitudinal Experience Evaluating Clinicopathologic Features and Breast Cancer Risk. J Clin Oncol. 2015; 33(33):3945-52. PMC: 4934644. DOI: 10.1200/JCO.2015.61.4743. View

Middleton L, Grant S, Stephens T, Stelling C, Sneige N, Sahin A . Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised?. Mod Pathol. 2003; 16(2):120-9. DOI: 10.1097/01.MP.0000051930.68104.92. View

10.

Meroni S, Stefano M, Bozzini A, Carla B, Pruneri G, Giancarlo P . Underestimation rate of lobular intraepithelial neoplasia in vacuum-assisted breast biopsy. Eur Radiol. 2014; 24(7):1651-8. DOI: 10.1007/s00330-014-3132-y. View

11.

Fisher B, Costantino J, Wickerham D, Cecchini R, Cronin W, Robidoux A . Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst. 2005; 97(22):1652-62. DOI: 10.1093/jnci/dji372. View

12.

Aroner S, Collins L, Schnitt S, Connolly J, Colditz G, Tamimi R . Columnar cell lesions and subsequent breast cancer risk: a nested case-control study. Breast Cancer Res. 2010; 12(4):R61. PMC: 2949654. DOI: 10.1186/bcr2624. View

13.

Bauer V, Ditkoff B, Schnabel F, Brenin D, El-Tamer M, Smith S . The management of lobular neoplasia identified on percutaneous core breast biopsy. Breast J. 2003; 9(1):4-9. DOI: 10.1046/j.1524-4741.2003.09102.x. View

14.

Nakhlis F, Ahmadiyeh N, Lester S, Raza S, Lotfi P, Golshan M . Papilloma on core biopsy: excision vs. observation. Ann Surg Oncol. 2014; 22(5):1479-82. DOI: 10.1245/s10434-014-4091-x. View

15.

Pareja F, Corben A, Brennan S, Murray M, Bowser Z, Jakate K . Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies: Rate of upgrade to carcinoma at excision. Cancer. 2016; 122(18):2819-27. PMC: 5014573. DOI: 10.1002/cncr.30118. View

16.

Sneige N, Wang J, Baker B, Krishnamurthy S, Middleton L . Clinical, histopathologic, and biologic features of pleomorphic lobular (ductal-lobular) carcinoma in situ of the breast: a report of 24 cases. Mod Pathol. 2002; 15(10):1044-50. DOI: 10.1097/01.MP.0000027624.08159.19. View

17.

Goss P, Ingle J, Ales-Martinez J, Cheung A, Chlebowski R, Wactawski-Wende J . Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med. 2011; 364(25):2381-91. DOI: 10.1056/NEJMoa1103507. View

18.

Weisman P, Sutton B, Siziopikou K, Hansen N, Khan S, Neuschler E . Non-mass-associated intraductal papillomas: is excision necessary?. Hum Pathol. 2014; 45(3):583-8. DOI: 10.1016/j.humpath.2013.10.027. View

19.

Mercado C . BI-RADS update. Radiol Clin North Am. 2014; 52(3):481-7. DOI: 10.1016/j.rcl.2014.02.008. View

20.

Foster M, Helvie M, Gregory N, Rebner M, Nees A, Paramagul C . Lobular carcinoma in situ or atypical lobular hyperplasia at core-needle biopsy: is excisional biopsy necessary?. Radiology. 2004; 231(3):813-9. DOI: 10.1148/radiol.2313030874. View