Atypical lobular hyperplasia or lobular carcinoma in situ at core-needle breast biopsy

PURPOSE: To review outcomes of lesions diagnosed at core-needle breast biop sy as atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS ). MATERIALS AND METHODS: Results from 1,400 consecutive core-needle breast bi opsies were reviewed. Twenty-five (1.8%) biopsy samples with the diagnosis of lobular neoplasia (15 with ALH and 10 with LCIS) adjacent to or in a tar geted benign lesion were found. Lesions were excised (n = 15) or followed u p (n = 10) at least 22 months. RESULTS: Of the 15 lesions with ALH, 13 (87%) were adjacent to (n = 12) or associated with (n = 1) microcalcifications, and two (13%) were in masses. Six lesions with residual calcifications were excised. One lesion was diagn osed as ductal carcinoma in situ (DCIS), and five were benign (residual ALH was seen in four). One excised mass showed residual ALH. Six lesions were gone at follow-up, one cluster of microcalcifications was decreased in size , and one fibroadenoma with ALH was stable. Of the 10 lesions with LCIS, se ven (70%) were adjacent to (n = 6) or associated with (n = 1) microcalcific ations, and three (30%) were in or adjacent to masses. Five lesions with LC IS and residual microcalcifications were excised. Three yielded atypical du ctal hyperplasia (ADH); one, residual LCIS; and one, ALH. Three masses with LCIS were excised. One showed residual LCIS; one, a papilloma with adjacen t LCIS; and one, a fibroadenoma with LCIS in it. One cluster of microcalcif ications was gone at follow-up, and one was stable. CONCLUSION: After a diagnosis of lobular neoplasia at core biopsy, residual microcalcifications are viewed in the context of a patient at higher risk of cancer. Of 11 lesions with residual microcalcifications, three (27%) wer e ADH and one (9%) was DCIS.