Some Women with Abnormal Breast Lesions May Avoid Surgery
Surgery is not always necessary for women with a type of breast tissue abnormality associated with a higher risk of cancer, according to a new study published online in Radiology. Researchers said that periodic imaging and clinical exam are effective in these patients when radiology and pathology findings are benign and concordant.
Atypical lobular hyperplasia and lobular carcinoma in situ are abnormal breast lesions that occasionally appear as incidental findings in breast biopsies. Women with atypical lobular hyperplasia or lobular carcinoma in situ have a 4 to 10 times higher risk of developing breast cancer, according to Michael A. Cohen, MD, FACR, Professor of Radiology at the Emory University School of Medicine in Atlanta. As a result, it is often recommended that atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on image-guided core biopsy be removed surgically.
"Because of the possibility of upgrade to cancer, the bulk of the published literature says that the prudent thing to do is excise atypical lobular hyperplasia and lobular carcinoma in situ," Dr. Cohen said.
But new research from Dr. Cohen, Kristen Atkins, MD, Associate Professor of Pathology at the University of Virginia in Charlottesville, Virginia, and colleagues may alter that thinking.
At one time, Drs. Cohen and Atkins were colleagues at the University of Virginia and had many discussions about balancing the risk of cancer in patients who have atypical lobular hyperplasia and lobular carcinoma in situ with the costs and potential complications of surgery.
"From a pathology perspective, atypical lobular hyperplasia and lobular carcinoma in situ are often very tiny lesions, so we wondered why they were getting excised," Dr. Atkins said. "These surgeries may involve general anesthesia and possible disfigurement."
Study Details
The researchers studied 10 years of pathology and radiology data to look for a correlation between the number of atypical lobular hyperplasia and lobular carcinoma in situ cases that were upgraded to cancer after surgery or follow-up and the concordance between the radiologist and pathologist.
The research yielded 50 cases from 49 women aged 40 to 73 years. Radiologist and pathologist findings were concordant in 43 of the 50 cases. None of the benign concordant cases were subsequently upgraded to cancer, strongly suggesting that observation in these patients would have been a viable alternative to surgery. Of the seven discordant cases, two were upgraded to ductal carcinoma in situ, an early-stage, noninvasive form of breast cancer.
Dr. Cohen repeated the study after moving to Emory and found the same results.
"When there's no discordance between the radiologist and pathologist after thorough radiology-pathology correlation, there's no upgrade from atypical lobular hyperplasia or lobular carcinoma in situ to cancer in our study," Dr. Cohen said. "These findings show that some women can avoid surgery, and that yearly mammograms along with magnetic resonance imaging or ultrasound as second-line screening tools may suffice."
The researchers suggested that their findings will help physicians and patients make informed decisions about atypical lobular hyperplasia and lobular carcinoma in situ.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
