Lobular Neoplasia In Breast Screen Setting Multicentre Study (St Vincent And Monash) Retrospective, Descriptive Study 23 Years (1993-2016)

Abstract

Background on Lobular neoplasms Spectrum of lesions encompassing atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS). LN is often multifocal and bilateral. LCIS SUBTYPES Classic Variant types (pleomorphic and LCIS with comedo  necrosis) SIGNIFICANCE Marker of increased risk for invasive carcinoma. LCIS: 8-9-fold risk of developing subsequent carcinoma ALH:4-5-fold risk Clinical guidance for the management of lobular carcinoma in situ(Cancer Australia) MDM Decision Concordant Classic LCIS on core needle biopsy. No other higher risk abnormalities that would impact management surveillance remains an appropriate option. Discordant    LCIS    on   core    needle    biopsy: Subsequent biopsy to obtain a larger tissue sample Other LCIS subtypes (pleomorphic or with comedo necrosis) or proliferative lesions present that require investigation, excision should be undertaken. Problem limited consensus recommendation for the management of lobular neoplasia in particular Classic LCIS. Research question: Incidence Radiological appearance Management Final outcome of screen-detected lobular neoplasia (LN)?               to help guide future management and evidence- based recommendations. Method Inclusion criteria: Patients with ALH and LCIS as the highest risk lesion on core biopsy were included Search parameters using ALH and/or LCIS diagnosis on core biopsy and high-risk status LCIS patients Exclusion criteria: Those with additional ADH, DCIS, invasive carcinoma and radial scar on core biopsy Analysis of Age, family history, Breast Screen round, lesion type Imaging Architectural distortion, mass, calcification Size Unilateral, Bilateral Imaging      concordance?      (calcification      or asymmetric               density  in                     this       group) Histopathology on excision or follow up period Results At both centers during 1993 -2016: 504 686 women were screened 1 913 245 screening mammograms were performed 72 patients met inclusion criteria 60 LCIS and 12 ALH on core biopsy; 16 with     LCIS – variant type Median screening round 3.5 (range 1 - 11) Incidence of LCIS 11.8 per 100 000 Breast Screen women Table A at the end of abstract