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Katrina N Glazebrook - One of the best experts on this subject based on the ideXlab platform.
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long term follow up of Lobular neoplasia atypical Lobular hyperplasia Lobular Carcinoma in situ diagnosed on core needle biopsy
Annals of Surgical Oncology, 2012Co-Authors: Miraj G Shahkhan, Carol Reynolds, Xochiquetzal J Geiger, James W Jakub, Elizabeth R Deperi, Katrina N GlazebrookAbstract:Background Lobular neoplasia (LN) includes atypical Lobular hyperplasia (ALH) and Lobular Carcinoma in situ (LCIS). LN often is an incidental finding on breast core needle biopsy (CNBx) and management remains controversial. Our objective was to define the incidence of malignancy in women diagnosed with pure LN on CNBx, and identify a subset of patients that may be observed.
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long term follow up of Lobular neoplasia atypical Lobular hyperplasia Lobular Carcinoma in situ diagnosed on core needle biopsy
Annals of Surgical Oncology, 2012Co-Authors: Miraj G Shahkhan, Carol Reynolds, Xochiquetzal J Geiger, James W Jakub, Elizabeth R Deperi, Katrina N GlazebrookAbstract:Lobular neoplasia (LN) includes atypical Lobular hyperplasia (ALH) and Lobular Carcinoma in situ (LCIS). LN often is an incidental finding on breast core needle biopsy (CNBx) and management remains controversial. Our objective was to define the incidence of malignancy in women diagnosed with pure LN on CNBx, and identify a subset of patients that may be observed. Patients diagnosed with LN on CNB between January 1993 and December 2010 were identified. Patients with an associated high-risk lesion or ipsilateral malignancy at time of diagnosis were excluded. All cases were reviewed by dedicated breast pathologists and breast imagers for pathologic classification and radiologic concordance, respectively. The study cohort was comprised of 184 (1.3 %) cases of pure LN (147 ALH, 37 LCIS) from 180 patients. Pathologic–radiologic concordance was achieved in 171 (93 %) cases. Excision was performed in 101 (55 %) cases and 83 (45 %) were observed. Mean follow-up was 50.3 (range, 6–212) months. Of cases excised, 1 of 81 (1.2 %) ALH and 1 of 20 (5 %) LCIS cases were upstaged to ductal Carcinoma in situ (DCIS) and invasive Lobular Carcinoma (ILC), respectively. Only 1 of 101 (1 %) concordant lesions was upstaged on excision. Of the cases observed, 4 of 65 (6.2 %) developed ipsilateral cancer during follow-up: 1 of 51 (2 %) case of ALH and 3 of 14 (21.4 %) cases with LCIS (2 ILC, 2 DCIS). During follow-up, 2.9 % (4/138) patients with excised or observed LN developed a contralateral cancer. These data support that not all patients with LN diagnosed on CNB require surgical excision. Patients with pure ALH, demonstrating radiologic–pathologic concordance, may be safely observed.
Sunil R Lakhani - One of the best experts on this subject based on the ideXlab platform.
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american registry of pathology expert opinions the spectrum of Lobular Carcinoma in situ diagnostic features and clinical implications
Annals of Diagnostic Pathology, 2020Co-Authors: Tari A. King, Edi Brogi, Stuart J Schnitt, Yunnyi Chen, Sunil R LakhaniAbstract:This review reflects a collaboration between the American Registry of Pathology (the publisher of the Armed Forces Institute of Pathology Fascicles) and Annals of Diagnostic Pathology. It is part of a series of expert recommendations on topics encountered in daily practice. The authors, 4 pathologists with expertise in breast pathology and a breast surgeon with a clinical and research interest in Lobular Carcinoma in situ (LCIS), met by conference call in September 2019 to develop recommendations for evaluating and reporting LCIS. Herein, we summarize the diagnostic criteria of classic LCIS and LCIS subtypes according to the most recent WHO criteria, discuss how best to distinguish LCIS from ductal Carcinoma in situ in problematic cases (including the uses and limitations of E-cadherin immunohistochemistry), and review outcome and management issues for patients with LCIS.
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Invasive Lobular Carcinoma of the breast: morphology, biomarkers and ’omics
Breast Cancer Research, 2015Co-Authors: Amy E Mccart Reed, Sunil R Lakhani, Jamie R Kutasovic, Peter T SimpsonAbstract:Invasive Lobular Carcinoma of the breast is the most common ‘special’ morphological subtype of breast cancer, comprising up to 15% of all cases. Tumours are generally of a good prognostic phenotype, being low histological grade and low mitotic index, hormone receptor positive and HER2, p53 and basal marker negative, and with a generally good response to endocrine therapy. Despite this, clinicians face countless challenges in the diagnosis and long-term management of patients, as they encounter a tumour that can be difficult to detect through screening, elicits a very invasive nature, a propensity for widespread metastatic colonisation and, consequently, in some studies a worse long-term poor outcome compared with invasive Carcinoma of no special type. Here we review the morphological and molecular features that underpin the disparate biological and clinical characteristics of this fascinating tumour type.
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the diagnosis and management of pre invasive breast disease pathology of atypical Lobular hyperplasia and Lobular Carcinoma in situ
Breast Cancer Research, 2003Co-Authors: Peter T Simpson, Sunil R Lakhani, Jorge S Reisfilho, Theodora Gale, Laura G FulfordAbstract:The term Lobular neoplasia refers to a spectrum of lesions featuring atypical Lobular hyperplasia and Lobular Carcinoma in situ (LCIS). The histopathological characteristics of these lesions are well documented. What is less well understood is the management implications of a patient diagnosed with LCIS; treatment regimes vary and are somewhat controversial. LCIS is now considered a risk factor and a non-obligate precursor for the subsequent development of invasive cancer.
Jan F Silverman - One of the best experts on this subject based on the ideXlab platform.
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follow up surgical excision is indicated when breast core needle biopsies show atypical Lobular hyperplasia or Lobular Carcinoma in situ a correlative study of 33 patients with review of the literature
The American Journal of Surgical Pathology, 2005Co-Authors: Tarik M Elsheikh, Jan F SilvermanAbstract:Abstract:Atypical Lobular hyperplasia (ALH) and Lobular Carcinoma in situ (LCIS) diagnosed in core needle biopsy (CNB) are generally regarded as risk indicators for developing invasive ductal or Lobular Carcinoma in either breast. Currently, there are no well-established guidelines for management of
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follow up surgical excision is indicated when breast core needle biopsies show atypical Lobular hyperplasia or Lobular Carcinoma in situ a correlative study of 33 patients with review of the literature
The American Journal of Surgical Pathology, 2005Co-Authors: Tarik M Elsheikh, Jan F SilvermanAbstract:Atypical Lobular hyperplasia (ALH) and Lobular Carcinoma in situ (LCIS) diagnosed in core needle biopsy (CNB) are generally regarded as risk indicators for developing invasive ductal or Lobular Carcinoma in either breast. Currently, there are no well-established guidelines for management of these patients. The most common management options are careful observation and endocrine chemoprophylaxis for high-risk patients. Previous studies had contradicting recommendations regarding follow-up surgical excision (FSE) of CNB yielding ALH or LCIS. These studies, unfortunately, have been limited by their retrospective nature, small number of patients examined, and association with other high-risk lesions. Only CNB diagnosed as pure LCIS or ALH (not associated with other high-risk lesions such as ADH, radial scar, or papilloma) were included in the study. We reviewed 33 CNB (20 ALH and 13 LCIS) with subsequent FSE from 33 patients (age range, 30-83 years; mean, 58 years). Eighteen of these patients were prospectively analyzed, where FSE was performed in an unselected fashion. All CNBs were obtained by mammotome (11-gauge, 30 cases; and 14-gauge, 3 cases). Mammography identified calcifications in 29 cases (88%) and a mass in 4 cases (12%). FSE revealed infiltrating ductal and/or Lobular Carcinoma in 4 of 13 LCIS (31%). FSE of 20 ALH revealed cancer in 5 cases (25%), including 4 ductal Carcinoma in situ (DCIS) and 1 invasive Lobular Carcinoma. Seven of these nine cancers were associated with calcifications, and two presented as masses. Sampling error and underestimation of cancer (DCIS or invasive Carcinoma) was associated with CNB diagnosis of LCIS or ALH in 27% of all cases. Underestimation of cancer was seen in 28% of prospectively examined patients, including 20% of ALH and 38% of LCIS. CNB associated with mass lesions or that showed histologic features of pleomorphic LCIS or extensive classic LCIS had a higher rate of cancer underestimation. Despite removal of all abnormal mammographic calcifications by CNB in 6 patients, one cancer was detected on FSE. To the best of our knowledge, this is the largest study reported to date, and the only one to include prospectively examined patients with no pre-selection bias. Our data strongly suggests that subsequent FSE is warranted in all patients with CNB diagnoses of LCIS or ALH, to exclude the presence of cancer.
Carol Reynolds - One of the best experts on this subject based on the ideXlab platform.
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long term follow up of Lobular neoplasia atypical Lobular hyperplasia Lobular Carcinoma in situ diagnosed on core needle biopsy
Annals of Surgical Oncology, 2012Co-Authors: Miraj G Shahkhan, Carol Reynolds, Xochiquetzal J Geiger, James W Jakub, Elizabeth R Deperi, Katrina N GlazebrookAbstract:Lobular neoplasia (LN) includes atypical Lobular hyperplasia (ALH) and Lobular Carcinoma in situ (LCIS). LN often is an incidental finding on breast core needle biopsy (CNBx) and management remains controversial. Our objective was to define the incidence of malignancy in women diagnosed with pure LN on CNBx, and identify a subset of patients that may be observed. Patients diagnosed with LN on CNB between January 1993 and December 2010 were identified. Patients with an associated high-risk lesion or ipsilateral malignancy at time of diagnosis were excluded. All cases were reviewed by dedicated breast pathologists and breast imagers for pathologic classification and radiologic concordance, respectively. The study cohort was comprised of 184 (1.3 %) cases of pure LN (147 ALH, 37 LCIS) from 180 patients. Pathologic–radiologic concordance was achieved in 171 (93 %) cases. Excision was performed in 101 (55 %) cases and 83 (45 %) were observed. Mean follow-up was 50.3 (range, 6–212) months. Of cases excised, 1 of 81 (1.2 %) ALH and 1 of 20 (5 %) LCIS cases were upstaged to ductal Carcinoma in situ (DCIS) and invasive Lobular Carcinoma (ILC), respectively. Only 1 of 101 (1 %) concordant lesions was upstaged on excision. Of the cases observed, 4 of 65 (6.2 %) developed ipsilateral cancer during follow-up: 1 of 51 (2 %) case of ALH and 3 of 14 (21.4 %) cases with LCIS (2 ILC, 2 DCIS). During follow-up, 2.9 % (4/138) patients with excised or observed LN developed a contralateral cancer. These data support that not all patients with LN diagnosed on CNB require surgical excision. Patients with pure ALH, demonstrating radiologic–pathologic concordance, may be safely observed.
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long term follow up of Lobular neoplasia atypical Lobular hyperplasia Lobular Carcinoma in situ diagnosed on core needle biopsy
Annals of Surgical Oncology, 2012Co-Authors: Miraj G Shahkhan, Carol Reynolds, Xochiquetzal J Geiger, James W Jakub, Elizabeth R Deperi, Katrina N GlazebrookAbstract:Background Lobular neoplasia (LN) includes atypical Lobular hyperplasia (ALH) and Lobular Carcinoma in situ (LCIS). LN often is an incidental finding on breast core needle biopsy (CNBx) and management remains controversial. Our objective was to define the incidence of malignancy in women diagnosed with pure LN on CNBx, and identify a subset of patients that may be observed.
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mr imaging of the breast in patients with invasive Lobular Carcinoma
American Journal of Roentgenology, 2001Co-Authors: Susan P Weinstein, Susan G Orel, Rose Heller, Carol Reynolds, Brian J Czerniecki, Lawrence J Solin, Mitchell D SchnallAbstract:OBJECTIVE. Our objective was to assess the usefulness of MR imaging in patients diagnosed with invasive Lobular Carcinoma of the breast.MATERIALS AND METHODS. Between July 1993 and September 1999, 32 women (33 cases) diagnosed with pure invasive Lobular Carcinoma of the breast underwent contrast-enhanced MR imaging examination. One woman was excluded because of lack of follow-up. Correlation was made between the mammographic and sonographic findings, the MR imaging findings, and the final pathology results for the remaining 32 cases.RESULTS.In 18 women who did not undergo excisional biopsy before the MR imaging, MR imaging showed more extensive tumor burden or the detection of the primary lesion that was occult on conventional imaging in seven (38.9%) of 18 women. In nine (50%) of 18 women, MR imaging performed equally as well as mammography and sonography. In one case (5.6%), MR imaging and mammography underestimated disease extent. In another patient (5.6%), MR imaging overestimated tumor burden, althou...
Lavinia P. Middleton - One of the best experts on this subject based on the ideXlab platform.
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Lobular Carcinoma In Situ Diagnosed By Core Needle Biopsy: When Should It Be Excised?
Modern Pathology, 2003Co-Authors: Lavinia P. Middleton, Shakeitha Grant, Tanya Stephens, Nour Sneige, Carol B. Stelling, Aysegul A SahinAbstract:Core needle biopsy is the preferred technique for evaluating breast masses and abnormal mammographic findings. The frequency of detection of noninvasive Lobular lesions by core needle biopsy is increasing. Historically, the diagnosis of Lobular Carcinoma in situ has been considered a risk factor for the development of invasive Carcinoma, and treatment has consisted of careful clinical follow-up with or without chemopreventive therapeutic agents such as tamoxifen citrate. We retrospectively reviewed core needle biopsy material with the primary diagnoses of Lobular Carcinoma in situ , atypical Lobular hyperplasia, and Lobular neoplasia in conjunction with clinical and radiographic findings to make recommendations as to when excision may be merited. We searched our database for core needle biopsy cases with Lobular Carcinoma in situ , atypical Lobular hyperplasia, and Lobular neoplasia as the primary diagnosis. Microcalcifications had been sampled with a stereotactically guided, 11 G Mammotome biopsy device, and masses had been sampled with an ultrasound guided, 18 G core needle. Glass slides were reviewed and histological parameters assessed. Mammographic findings were reviewed, and clinical information was obtained from the medical record. When available, excisional biopsy material was reviewed. The 2337 breast core needle biopsies performed from January 1995 to December 2001 included 35 (1.5%) with classic Lobular Carcinoma in situ (14), Lobular neoplasia (4), and atypical Lobular hyperplasia (17) as the primary diagnosis. Twelve of these 35 cases (34%) had histological evidence of microcalcifications directly associated with the Lobular Carcinoma in situ , Lobular neoplasia, atypical Lobular hyperplasia. Radiologic review revealed 21 calcifications, 6 ultrasonographic masses, and 8 mammographic masses and/or architectural distortions. Excisional biopsy had been performed in 17 cases (49%). In six cases diagnosed as in situ on core needle biopsy, excisional biopsy revealed invasive Carcinoma. All of these patients had radiographically detectable masses. Eleven cases had excisional biopsies that showed histology similar to that of the core needle biopsies. The most important predictor of invasive Carcinoma on excision was a synchronous mass lesion. Lobular Carcinoma in situ involving adenosis and Lobular Carcinoma in situ with pagetoid spread on core needle biopsies did not show a histologically more aggressive lesion on excision and, therefore, may not require additional surgery. Histologically identified calcifications were associated with Lobular lesions 34% of the time; however, their presence inside an in situ Lobular lesion did not portend worse pathology on re-excision and should not be a criterion for excision. Based on these findings, we recommend excisional biopsy of Lobular Carcinoma in situ , atypical Lobular hyperplasia or Lobular neoplasia only when it is associated with a synchronous mass lesion.
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Clinical, Histopathologic, and Biologic Features of Pleomorphic Lobular (Ductal-Lobular) Carcinoma In Situ of the Breast: A Report of 24 Cases
Modern Pathology, 2002Co-Authors: Nour Sneige, Jianzhou Wang, Barbara A Baker, Savitri Krishnamurthy, Lavinia P. MiddletonAbstract:We reviewed 10 cases of pleomorphic Lobular (ductal Lobular) Carcinoma in situ (PL/DLCIS) of the breast and compared them with 14 cases of pleomorphic Lobular Carcinoma in situ (PLCIS) found in association with invasive pleomorphic Lobular Carcinoma. The histologic features; immunohistochemical staining for estrogen receptors (ERs), p53, Ki67, E-cadherin, and gross cystic disease fluid protein-15 (GCDFP-15); and results of fluorescence in situ hybridization for HER-2 /neu gene amplification were evaluated in all 24 cases. Histologically, PL/DLCIS cells were similar to those of PLCIS with invasion in that they were discohesive and medium to large in size with moderate to marked nuclear pleomorphism, small to prominent nucleoli, and moderate to abundant eosinophilic or vacuolated cytoplasm. In both groups, central necrosis was present in a small number of cases, and classic LCIS coexisted with the in situ lesion in less than half of the cases; in situ Carcinomas were positive for ERs in 23 (100%) of 23 cases, p53 in 6 (25%) of 24 cases, and GCDFP-15 in 14 (74%) of 19 cases. The percentage of Ki67-positive tumor nuclei indicated moderate to high (more than 20%) proliferative activity in 8 (47%) of 17 cases. Immunostaining for E-cadherin was negative in all 24 cases. HER-2 /neu gene amplification was observed in 1 (4%) of 23 cases. In cases with associated invasion, PLCIS had cytologic features and immunostaining patterns similar to those of the invasive pleomorphic component. Seven of the 10 patients who had PL/DLCIS without invasion underwent lumpectomy or simple mastectomy. Six of these patients had no evidence of disease in follow-up periods ranging from 4 to 32 months; the seventh patient developed recurrent disease 12 months after undergoing lumpectomy. We conclude that the cytologic features and biomarker expression profile of PL/DLCIS are similar to those of PLCIS with invasion but somewhat different from those of classic LCIS and ductal Carcinoma in situ . Long-term follow-up studies are needed to further define the natural history of PL/DLCIS and its optimal management.
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pleomorphic Lobular Carcinoma morphology immunohistochemistry and molecular analysis
The American Journal of Surgical Pathology, 2000Co-Authors: Lavinia P. Middleton, D M Palacios, Bonita R Bryant, Patricia A Krebs, Christopher N Otis, Maria J MerinoAbstract:Infiltrating pleomorphic Lobular Carcinoma (PLC) is an aggressive variant of infiltrating Lobular Carcinoma. Recently, in situ changes identical to PLC (PLCIS) have been described. The role of prognostic markers and their correlation with therapeutics, clinical outcome, and genetic changes is not well established in PLC. The authors examined 38 cases of this entity to understand better this tumor's biology. Immunohistochemical (IHC) analysis was performed in 21 specimens for estrogen and progesterone steroid receptors, p53, Her 2 (p185), and GCDFP-15. Genomic deoxyribonucleic acid was obtained from microdissected tumor as well as normal control cells, and loss of heterozygosity was investigated at the ESR (16q24), p53 (TP53 17p), Her 2 (17q 11-12), and BRCA 1 (17q12-25) loci. In this series, the average patient age was 57.5 years (age range, 24-92 years). Twenty-seven women were postmenopausal. Tumor size ranged from 1.2 to 25 cm. Six patients were a pathologic stage I; 19, stage II; 12, stage III; and one, stage IV. Histologically, multifocal nodular aggregates of discohesive pleomorphic tumor cells were seen interspersed in dense and fibrotic breast parenchyma. Twenty-nine percent of the specimens demonstrated associated signet ring cells. The remainder had dishesive, globoid, plasmacytoid cells with high-grade nuclear features. PLCIS was identified in 17 of 38 patients (45%), and Lobular Carcinoma in situ (LCIS) was noted in 8 patients (21%). IHC analysis showed estrogen immunoreactivity in 81%, progesterone in 67%, GCDFP-15 in 71%, and Her 2 in 81% (2+ to 3+ membranous staining) of specimens. Antibodies to p53 stained the tumor cell nuclei in 48% of the tumors. Loss of heterozygosity was identified in 52% of the specimens at the p53 locus, 18% at the ESR locus, 19% to 24% at the Her 2 loci, and 27% to 32% at the BRCA 1 locus. Follow-up was available in 19 patients and ranged from 12 months to 15 years (mean, 73 months). Seven patients had no evidence of disease at last examination (range, 1-15 years), three patients were alive with disease (range, 2-14 years), and nine patients were dead of disease (range, 2 months-9 years). Six patients had subsequent diagnoses of tumor in the contralateral breast. Analysis shows that PLC tends to appear in older postmenopausal women who present with locally advanced disease. PLCIS was found to be associated with PLC 45% of the time. The aggressive clinical course of patients with PLC is supported by tumor immunoreactivity with unfavorable markers Her 2 and p53. Overexpression of Her 2 in PLC may be therapeutically relevant, enabling the use of novel chemotherapeutic drugs like Herceptin. Interestingly, tumors that were Her 2 immunoreactive also maintained estrogen hormone immunoreactivity.