HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kopans, D. B. Search for Related Content PubMed PubMed Citation Articles by Kopans, D. B. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

LCIS Found at Core Needle Biopsy May Not Need Surgical Excision

Massachusetts General Hospital Boston, MA 02114

WEB—This is a Web exclusive article.

The article by Brem et al. [1] concerning core needle biopsies of breast lesions that result in lobular carcinoma in situ (LCIS) as the "highest-grade" lesion, adds a large group of patients to other studies previously published on the subject [2, 3]. Unfortunately, we are no closer to knowing the true reason that these various institutions found a very high rate of cancer among these women when they underwent surgical excision. These are all retrospective and selective studies. The data are from a period of time before anyone was concerned about LCIS in core biopsies, and the patients likely underwent excisional biopsy because the core biopsy results were discordant with the imaging findings. This greatly biases the results and leads to conclusions that are not supported by the data.

In this latest report [1], only 164 (59%) of 278 women with LCIS or atypical lobular hyperplasia as the "highest-grade pathologic lesion" went on to have an excisional biopsy, creating a major selection bias. Because LCIS (except pleomorphic LCIS) has no imaging correlate, the obvious explanation is that the core biopsy results for the women who went on to have a surgical excision were discordant with the imaging finding leading to the excision.

Assume a spiculated mass was targeted and the worst pathology result was LCIS. This is clearly not concordant, and the radiologist would recommend excision. We would not be surprised if a cancer was ultimately diagnosed. A retrospective review of such discordant core biopsies would result in a fairly high rate of cancers. It is not the presence of the LCIS that suggests undersampling but more than likely simply discordant core biopsy results.

Only prospective data in which all women in this category go on to excisional biopsy can answer the question. I suspect that the likelihood of unsuspected cancer being diagnosed will be much less than what has been reported and that the few cases that will be found will, most likely, be coincidental. Until such a study is done, on the basis of these retrospective reviews, a large number of women will undergo excisional biopsies who likely do not need the surgery.

References

1. Brem RF, Lechner MC, Jackman RJ, et al. Lobular neoplasia at percutaneous breast biopsy: variables associated with carcinoma at surgical excision. AJR 2008;190 : 637–641[Abstract/Free Full Text]
2. Liberman L, Sama M, Susnik B, et al. Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings. AJR 1999; 173:291 –299[Abstract/Free Full Text]
3. Crisi GM, Mandavilli S, Cronin E, Ricci A Jr. Invasive mammary carcinoma after immediate and short-term follow-up for lobular neoplasia on core biopsy. Am J Surg Pathol 2003;27 : 325–333[CrossRef][Medline]

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati

This article has been cited by other articles:

				T. J. Lawton and D. Georgian-Smith Excision of High-Risk Breast Lesions on Needle Biopsy: Is There a Standard of Core? Am. J. Roentgenol., May 1, 2009; 192(5): W268 - W268. [Full Text] [PDF]

				R. F. Brem, R. J. Jackman, and M. C. Lechner Reply Am. J. Roentgenol., September 1, 2008; 191(3): W153 - W153. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kopans, D. B. Search for Related Content PubMed PubMed Citation Articles by Kopans, D. B. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?