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Keywords:
Breast, Percutaneous, Biopsy, Cancer
Authors:
P. Merino Rasillo, S. M. Sanchez Gomez, P. Alonso Bartolomé, E. Ortega García, A. Lamagrande Obregón, A. Vega Bolivar; Santander/ES
DOI:
10.1594/ecr2015/C-0641
Aims and objectives
“Lobular neoplasia” is a term that encompasses two entities,
atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS).
The cells of both ALH and CLIS are small,
uniform,
discohesive,
and generally lack nucleoli.
The degree of involvement of the lobular units distinguishes these two entities,
and although some disagreement,
its widely accepted the definition by Page el al.
(1) ,
which sets that for LCIS it´s required that at least 50% of the acinar units in a lobule must be “filled and distended” by lobular neoplastic cells.
The definition of distention was further quantified to require the presence of at least eight lobular neoplastic cells spanning an individual acinar unit (2).
If a lobular unit does not fulfill these criteria,
a diagnosis of ALH is made.
According to literature,
LN has no generally recognized distinct mammographic correlation,
so its real incidence in the population is unknown.
With the advances in breast imaging, the detection of subtle calcifications and masses has become increasingly routine,
which has supposed an increase in the diagnosis of LN,
a diagnosis that encompasses 0.3%-3.8% of breast biopsies (3,4).
The management of LN remains a topic that continues to be discussed,
with the treatment of choice ranging from close imaging surveillance,
open surgical biopsy,
or chemoprophylactic therapy to prophylactic mastectomy (5-7).
Because of this controversy,
there are no clear guidelines for the management of LN.
The use of vacuum-assisted biopsy systems instead of 14G automatic gun,
especially for performing stereotactic biopsies in case of microcalcifications,
supposes a lower frequency of histologic underestimation (8) and a lower false-negative results,
with an overall improvement in lesion characterization.
The purpose of this study was to determine the frequency of malignancy after surgical excision of vacuum-assisted biopsy-proven lobular neoplasia (LCIS or ALH),
and to evaluate the outcome of lesions that were followed up instead of surgically excised.