Surgery not a must for abnormal breast lesions

Some women with atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) can delay or avoid surgery and instead undergo periodic imaging and clinical examination, as long as radiology and pathology findings are benign and concordant.

ALH and LCIS occasionally appear as incidental findings in breast biopsies. The presence of these abnormal breast lesions increases the person's risk for developing breast cancer.

“Because of the possibility of upgrade to cancer, the bulk of the published literature says that the prudent thing to do is excise ALH and LCIS,” explained investigator  Michael A. Cohen, MD, in a statement from the Radiological Society of North America (RSNA) describing the new findings. Cohen, who is a radiology professor at Emory University School of Medicine in Atlanta, Georgia, and colleagues published their findings in the RSNA journal Radiology

Cohen's group explored whether establishing radiologic-pathologic concordance could limit the number of patients requiring surgical excision when ALH or LCIS is diagnosed at core biopsy. The researchers studied a 10-year period in a pathology database to identify core biopsies that yielded ALH or LCIS devoid of any additional lesion that independently necessitated excision. All cases had to have had either subsequent surgical excision or a minimum of 2 years of imaging follow-up.

A total of 50 cases, from 49 women aged 40 to 73 years (mean age, 59 years), fit the criteria. Cohen and coauthors performed detailed radiologic-pathologic analysis while blinded to subsequent follow-up information. They compared all biopsy-related images with the histologic findings at core biopsy then designated each core biopsy finding as concordant or discordant. Results of subsequent surgery or extended follow-up for each case were then revealed and compared with the concordant or discordant designations.

Radiologist and pathologist findings were concordant in 43 of the cases, none of which had been subsequently upgraded to cancer at surgery or extended follow-up. These results strongly suggest that observation would have been a viable alternative to surgery for these patients.

Of the seven discordant biopsy findings, two were upgraded to ductal carcinoma in situ at surgery; none were upgraded at follow-up.
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