Management of lobular neoplasia diagnosed by core needle biopsy: Study of 52 biopsies with follow-up surgical excision

Management of lobular neoplasia diagnosed by core needle biopsy: Study of 52 biopsies with follow-up surgical excision
Vincent Lavoué, Olivier Graesslin, Jean Marc Classe, Eric Fondrinier, Hélène H. Angibeau, Jean Levêque
TheBreast (2007) 16, 533 – 539
Abstract

Lobular neoplasia (LN) is a risk factor for bilateral breast cancer without consensus as to its appropriate management. The authors report on a retrospective multi-institutional study concerning 52 patients in whom a diagnosis of LN was made after core needle biopsy (CNB) and who subsequently underwent surgical excision. The excision specimens revealed seven cases of invasive carcinoma and three cases of ductal carcinoma in situ, indicating an underestimation of lesions at CNB in 19% of cases, and in particular in those patients with pleomorphic LN, and when clinical, radiological masses were detected. This lesion is increasingly being diagnosed by CNB due to widespread screening. Follow-up surgical excision should be performed in order to examine the whole lesion in the case of masses or when the histologic specimen reveals a pleomorphic subtype. In other cases, annual mammographic surveillance should be undertaken due to the persistent long-term risk of developing bilateral breast cancer

Pathological classification of ductal carcinoma in situ of the breast correlates with surgical treatment and may be predicted by mammography

Pathological classification of ductal carcinoma in situ of the breast correlates with surgical treatment and may be predicted by mammography
Riccardo Ponzone, Annelis Dominguez, Vincenzo Marra, Alberto Pisacane, Furio Maggiorotto, Maria Elena Jacomuzzi, Alessandra Magistris, Nicoletta Biglia, Piero Sismondi
TheBreast (2007) 16, 495 – 502
Abstract

No significant differences in the distribution of clinical and pathological variables were detected among whole and limited series. The lesions were grouped into two (low versus high) pathological (PRG), radiological (RRG and CaRG) and needle biopsy (C/BRG) risk groups. PRG was associated with both RRG (p=0.002) and CaRG (p=0000), but not with C/BRG. Correlations with surgical outcome were also explored, with lesions of high PRG being more likely to undergo re-excision for inadequate first wide local excision [odds ratio (OR)=2.1], mastectomy (OR=2.6) and nodal staging procedures (OR=3.8) in the whole series. Conversely, no significant correlation was found between PRG, RRG, CaRG and C/BRG with surgical outcome in the limited series. We suggest that pathological features of DCIS are associated with surgical outcome and may be predicted by mammography

Role of pre-surgical breast MRI in the management of invasive breast carcinoma

Role of pre-surgical breast MRI in the management of invasive breast carcinoma
Chiara Del Frate, Ludovica Borghese, Carla Cedolini, Alexia Bestagno, Fabio Puglisi, Miriam Isola, Franca Soldano, Massimo Bazzocchi
TheBreast (2007) 16, 469 - 481
Abstract

Breast MRI determined an overall change in management in 22 out of 121 breasts (18.2%), and in two out of 87 breasts (25.3%) in patients eligible for conservative surgery. In the evaluation of single breasts, MRI resulted in true-positive in 22 out of 29 breasts (75.9%), false-positive in 7 out of 29 breasts (24.1%), leading to over-treatment in women whose treatment was changed from conservative surgery to radical mastectomy. MRI sensitivity in the detection of additional foci not seen on conventional imaging was 57.4%, overall sensitivity 87.4%, sensitivity for invasive cancers 93.1%, while for ductal carcinoma in situ it was 58.8%. In conclusion, breast MRI determines a significant change in the management of patients affected by invasive breast carcinoma, particularly in patients eligible for conservative surgery after standard breast examination