Atypical Lobular Hyperplasia or Lobular Carcinoma in Situ at Core-Needle Breast Biopsy

PURPOSE: To review outcomes of lesions diagnosed at core-needle breast biopsy as atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS).

MATERIALS AND METHODS: Results from 1,400 consecutive core-needle breast biopsies were reviewed. Twenty-five (1.8%) biopsy samples with the diagnosis of lobular neoplasia (15 with ALH and 10 with LCIS) adjacent to or in a targeted benign lesion were found. Lesions were excised (n = 15) or followed up (n = 10) at least 22 months.

RESULTS: Of the 15 lesions with ALH, 13 (87%) were adjacent to (n = 12) or associated with (n = 1) microcalcifications, and two (13%) were in masses. Six lesions with residual calcifications were excised. One lesion was diagnosed as ductal carcinoma in situ (DCIS), and five were benign (residual ALH was seen in four). One excised mass showed residual ALH. Six lesions were gone at follow-up, one cluster of microcalcifications was decreased in size, and one fibroadenoma with ALH was stable. Of the 10 lesions with LCIS, seven (70%) were adjacent to (n = 6) or associated with (n = 1) microcalcifications, and three (30%) were in or adjacent to masses. Five lesions with LCIS and residual microcalcifications were excised. Three yielded atypical ductal hyperplasia (ADH); one, residual LCIS; and one, ALH. Three masses with LCIS were excised. One showed residual LCIS; one, a papilloma with adjacent LCIS; and one, a fibroadenoma with LCIS in it. One cluster of microcalcifications was gone at follow-up, and one was stable.

CONCLUSION: After a diagnosis of lobular neoplasia at core biopsy, residual microcalcifications are viewed in the context of a patient at higher risk of cancer. Of 11 lesions with residual microcalcifications, three (27%) were ADH and one (9%) was DCIS.


  • 1 Haagensen CD, Lane N, Lattes R, Bodian C. Lobular neoplasia (so-called lobular carcinoma in situ) of the breast. Cancer 1978; 42:737-769. Crossref, MedlineGoogle Scholar
  • 2 Pope TL, Jr, Fechner RE, Wilhelm MC, Wanebo HJ, de Paredes ES. Lobular carcinoma in situ of the breast: mammographic features. Radiology 1988; 168:63-66. LinkGoogle Scholar
  • 3 Beute BJ, Kalisher L, Hutter RV. Lobular carcinoma in situ of the breast: clinical, pathologic, and mammographic features. AJR Am J Roentgenol 1991; 157:257-265. Crossref, MedlineGoogle Scholar
  • 4 Sonnenfeld MR, Frenna TH, Weidner N, Meyer JE. Lobular carcinoma in situ: mammographic-pathologic correlation of results of needle-directed biopsy. Radiology 1991; 181:363-367. LinkGoogle Scholar
  • 5 Liberman L, Sama M, Susnik B, et al. Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings. AJR Am J Roentgenol 1999; 173:291-299. Crossref, MedlineGoogle Scholar
  • 6 Philpotts LE, Shaheen NA, Carter D, Lange RC, Lee CH. Comparison of rebiopsy rates after stereotactic core needle biopsy of the breast with 11-gauge vacuum suction probe versus 14-gauge needle and automatic gun. AJR Am J Roentgenol 1999; 172:683-687. Crossref, MedlineGoogle Scholar
  • 7 Liberman L, Dershaw DD, Rosen PP, Abramson AF, Deutch BM, Hann LE. Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed?. Radiology 1994; 192:793-795. LinkGoogle Scholar
  • 8 Berg WA, Jaeger B, Campassi C, Kumar D. Predictive value of specimen radiography for core needle biopsy of noncalcified breast masses. AJR Am J Roentgenol 1998; 171:1671-1678. Crossref, MedlineGoogle Scholar
  • 9 Foote F, Stewart F. Lobular carcinoma in situ: a rare form of mammary cancer. Am J Pathol 1941; 17:491-495. MedlineGoogle Scholar
  • 10 Rosner D, Bedwani RN, Vana J, Baker HW, Murphy GP. Noninvasive breast carcinoma: results of a national survey by the American College of Surgeons. Ann Surg 1980; 192:139-147. Crossref, MedlineGoogle Scholar
  • 11 Newman W. Lobular carcinoma of the female breast. Ann Surg 1966; 164:305-314. Crossref, MedlineGoogle Scholar
  • 12 Ashikari R, Hajdu SI, Robbins GF. Intraductal carcinoma of the breast (1960– 1969). Cancer 1971; 5:1182-1187. Google Scholar
  • 13 Salvadori B, Bartoli C, Zurrida S, et al. Risk of invasive cancer in women with lobular carcinoma in situ of the breast. Eur J Cancer 1991; 27:35-37. Crossref, MedlineGoogle Scholar
  • 14 Andersen JA. Lobular carcinoma in situ of the breast: an approach to rational treatment. Cancer 1977; 39:2597-2602. Crossref, MedlineGoogle Scholar
  • 15 Rosen PP, Kosloff C, Lieberman PH, Adair F, Braun DW, Jr. Lobular carcinoma in situ of the breast: detailed analysis of 99 patients with average follow-up of 24 years. Am J Surg Pathol 1978; 2:225-251. Crossref, MedlineGoogle Scholar
  • 16 Nielsen M. Autopsy studies of the occurrence of cancerous, atypical and benign epithelial lesions in the female breast. APMIS Suppl 1989; 10:1-56. MedlineGoogle Scholar
  • 17 McDivitt RW, Hutter RV, Foote FW, Jr, Stewart FW. In situ lobular carcinoma: a prospective follow-up study indicating cumulative patient risks. JAMA 1967; 201:82-86. Crossref, MedlineGoogle Scholar
  • 18 Hutter RV, Foote FW, Jr. Lobular carcinoma in situ: long term follow-up. Cancer 1969; 24:1081-1085. Crossref, MedlineGoogle Scholar
  • 19 Horn PL, Thompson WD, Schwartz SM. Factors associated with the risk of second primary breast cancer: an analysis of data from the Connecticut Tumor Registry. J Chronic Dis 1987; 40:1003-1011. Crossref, MedlineGoogle Scholar
  • 20 Page DL, Dupont WD, Rogers LW, Rados MS. Atypical hyperplastic lesions of the female breast: a long-term follow-up study. Cancer 1985; 55:2698-2708. Crossref, MedlineGoogle Scholar
  • 21 Page DL, Kidd TE, Jr, Dupont WD, Simpson JF, Rogers LW. Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol 1991; 22:1232-1239. Crossref, MedlineGoogle Scholar
  • 22 Frykberg ER, Santiago F, Betsill WL, Jr, O’Brien PH. Lobular carcinoma in situ of the breast. Surg Gynecol Obstet 1987; 164:285-301. MedlineGoogle Scholar
  • 23 Fisher ER, Costantino J, Fisher B, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) Protocol B-17: five-year observations concerning lobular carcinoma in situ. Cancer 1996; 78:1403-1416. Crossref, MedlineGoogle Scholar
  • 24 Shah JP, Rosen PP, Robbins GF. Pitfalls of local excision in the treatment of carcinoma of the breast. Surg Gynecol Obstet 1973; 136:721-725. MedlineGoogle Scholar
  • 25 Carter D, Smith RR. Carcinoma in situ of the breast. Cancer 1977; 40:1189-1193. Crossref, MedlineGoogle Scholar
  • 26 Rosen PP, Senie R, Schottenfeld D, Ashikari R. Noninvasive breast carcinoma: frequency of unsuspected invasion and implications for treatment. Ann Surg 1979; 189:377-382. Crossref, MedlineGoogle Scholar
  • 27 Ottesen GL, Graversen HP, Blichert-Toft M, Zedeler K, Andersen JA. Lobular carcinoma in situ of the female breast: short-term results of a prospective nationwide study—the Danish Breast Cancer Cooperative Group. Am J Surg Pathol 1993; 17:14-21. Crossref, MedlineGoogle Scholar
  • 28 Page DL, Steel CM, Dixon JM. ABC of breast diseases: carcinoma in situ and patients at high risk of breast cancer. Br Med J 1995; 310:39-42. Crossref, MedlineGoogle Scholar
  • 29 Lechner MC, Jackman RJ, Brem RF, Evans W, III, Parker SH, Smid AP. Lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous biopsy with surgical correlation: a multi-institutional study (abstr). Radiology 1999; 213(P):106. Google Scholar
  • 30 Koerner F, Maluf H. Uncommon morphologic patterns of lobular neoplasia. Ann Diagn Pathol 1999; 3:249-259. Crossref, MedlineGoogle Scholar
  • 31 Wellings SR, Jensen HM, Marcum RG. An atlas of subgross pathology of the human breast with special reference to possible precancerous lesions. J Natl Cancer Inst 1975; 55:231-273. MedlineGoogle Scholar
  • 32 Page DL, Dupont WD, Rogers LW. Ductal involvement by cells of atypical lobular hyperplasia in the breast: a long-term follow-up study of cancer risk. Hum Pathol 1988; 19:201-207. Crossref, MedlineGoogle Scholar
  • 33 Jackman RJ, Burbank F, Parker SH, et al. Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: improved reliability with 14-gauge, directional, vacuum-assisted biopsy. Radiology 1997; 204:485-488. LinkGoogle Scholar
  • 34 Brem RF, Behrndt VS, Sanow L, Gatewood OM. Atypical ductal hyperplasia: histologic underestimation of carcinoma in tissue harvested from impalpable breast lesions using 11-gauge stereotactically guided directional vacuum-assisted biopsy. AJR Am J Roentgenol 1999; 172:1405-1407. Crossref, MedlineGoogle Scholar
  • 35 Moll R, Mitze M, Frixen UH, Birchmeier W. Differential loss of E-cadherin expression in infiltrating ductal and lobular breast carcinomas. Am J Pathol 1993; 143:1731-1742. MedlineGoogle Scholar
  • 36 Zschiesche W, Schonborn I, Behrens J, et al. Expression of E-cadherin and catenins in invasive mammary carcinomas. Anticancer Res 1997; 17:561-567. MedlineGoogle Scholar
  • 37 Ioffe O, Silverberg SG, Simsir A. Lobular lesions of the breast: immunohistochemical profile and comparison with ductal proliferations (abstr). Mod Pathol 2000; 13:23A. Google Scholar
  • 38 Gundry KR, Berg WA. Treatment issues and core needle breast biopsy: clinical context. AJR Am J Roentgenol 1998; 171:41-49. Crossref, MedlineGoogle Scholar
  • 39 Selim A, Tahan SR. Microscopic localization of calcifications in and around breast carcinoma: a cautionary note for needle core biopsies. Ann Surg 1998; 228:95-98. Crossref, MedlineGoogle Scholar
  • 40 Parker SH, Burbank F, Jackman RJ, et al. Percutaneous large-core breast biopsy: a multi-institutional study. Radiology 1994; 193:359-364. LinkGoogle Scholar
  • 41 Liberman L, Dershaw DD, Glassman JR, et al. Analysis of cancers not diagnosed at stereotactic core breast biopsy. Radiology 1997; 203:151-157. LinkGoogle Scholar
  • 42 Tavassoli FA. Ductal carcinoma in situ: introduction of the concept of ductal intraepithelial neoplasia. Mod Pathol 1998; 11:140-154. MedlineGoogle Scholar
  • 43 Vicini FA, Goldstein NS, Kestin LL. Pathologic and technical considerations in the treatment of ductal carcinoma in situ of the breast with lumpectomy and radiation therapy. Ann Oncol 1999; 10:883-890. Crossref, MedlineGoogle Scholar
  • 44 Berg WA, Krebs TL, Campassi C, Magder LS, Sun CC. Evaluation of 14- and 11-gauge directional, vacuum-assisted biopsy probes and 14-gauge biopsy guns in a breast parenchymal model. Radiology 1997; 205:203-208. LinkGoogle Scholar
  • 45 Dershaw DD, Morris EA, Liberman L, Abramson AF. Non-diagnostic stereotaxic core breast biopsy: results of rebiopsy. Radiology 1996; 198:323-326. LinkGoogle Scholar

Article History

Published in print: Feb 2001