[Lobular intra-epithelial neoplasia: atypical lobular hyperplasia and lobular carcinoma in situ]

[Shall all lobular intraepithelial neoplasia diagnosed on image-guided biopsy require a surgical management?]

OBJECTIVE

Lobular intraepithelial neoplasia (LIN) diagnosed on image-guided biopsy may be associated with an undiagnosed cancer. This is called under-diagnosis. The consequence is that management of these lesions is often surgical. But many surgeries finally are unnecessary. The aim of our study was to define criteria to avoid unnecessary surgery.

MATERIALS AND METHODS

This is a single-center, retrospective after a database collected prospectively study. Fourteen thousand biopsies were analyzed, including 456 diagnosed NLI. Under-diagnosis rates were analyzed according to many criteria. The average duration of following was 45 months.

RESULTS

For atypical lobular hyperplasia (ALH), we obtained 7.6% under-diagnosis and combining several criteria, we got a low risk of cancer (2%). For LCIS, this rate was 23% and any low-risk group could be identified.

CONCLUSION

ALH with calcifications≤20 mm, without any atypical lesion associated, histologically focal and whose removal is representative may be safely observed. For other LIN, surgery remains indicated.

[Pleomorphic lobular intraepithelial neoplasia: clinical, histological and prognostic study of nine cases]

INTRODUCTION

Retrospective clinical, histological and prognostic study of nine cases of lobular intraepithelial neoplasia in its pleomorphic subtype (LIN-P).

PATIENTS AND METHODS

Analysis of our center database with selection of nine cases of LIN-P from 140 files of patients who underwent surgical excision with a final diagnosis of LIN (2000 to 2011). The medical files were reviewed with a re-analysis of the mammograms and the histological slides. The outcome of the patients was also analyzed according to their clinical and operative data.

RESULTS AND DISCUSSION

The average age at diagnosis was 63 years (later than common LIN [LIN-C]). All patients had mammograms classified ACR 4 and 5, mainly due to the presence of microcalcifications (seven cases) with a case of opacity associated with microcalcifications, and two other cases with only isolated opacities. The preoperative diagnosis of these lesions was difficult: five cases on nine core needle biopsies were reviewed and reclassified LIN-P after finding the presence of LIN-P on the surgical specimen. Associated invasive lesions were found in 55% of core needle biopsy and in 33% of cases of surgical resection specimen. The treatment included a wide surgical excision (five lumpectomies and four mastectomies with a patient who had two lumpectomies) with margins of more than 2mm: we noted a recurrence of LIN-P only in one case where margins were very close (1mm). The analysis of our cases confirms that LIN-P if they probably share the same origin as the LIN-C represent a particular form constituting a true precancerous condition warranting at least a wide surgical excision.

[Diagnosis of lobular neoplasia in situ on percutaneous breast biopsy: surgical indication]

The arrival of modern imagery techniques has generated an increase in diagnosed lobular intra epithelial neoplasia (LIN) cases. The aim of this research is to define standards to assess the reliability of surgical action currently advised after diagnosing LIN on percutaneous breast biopsy.

MATERIALS AND METHODS

This retrospective research was conducted from January 1999 to December 2008 on 24 patients. After performing of mammotome procedure on micocalcifications, each diagnosed LIN case was reviewed by two anatomopathologists. The extent and type of LIN (1 and 2) tumor was defined. A further analysis of the surgically removed material was carried out.

RESULTS

The study has indicated three cases of underestimation (12.5%). It was CCIS. The analysis of mammotome procedure shown that the extent and type of LIN were inconstant.

CONCLUSIONS

The rate of underestimation is low but it appears that the extend and type of LIN's tumor on mammotome procedure is not available for the surgical decision.