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