Imaging follow up, not biopsy, suffices for some breast lesions

Concordance between radiologic and pathologic findings may allow some women diagnosed with atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) to be followed up via observation rather than biopsy, according to results of a study published online July 30 in Radiology.

ALH and LCIS, typically incidental findings that signify a future increased risk for breast cancer, are problematic diagnoses and subject to contradictory management recommendations. While some experts promote observation, most published literature suggests surgical excision.

“From a pathology perspective, ALH and LCIS are often very tiny lesions, so we wondered why they were getting excised,” Kristen A. Atkins, MD, from the department of pathology at University of Virginia in Charlottesville, said in a release. “These surgeries may involve general anesthesia and possible disfigurement.”

Atkins and colleagues sought to determine the utility of precise radiologic-pathologic correlation for establishing concordance or discordance in these cases, and thus inform the decision to biopsy or not.

The researchers reviewed the pathology database to identify core biopsies of ALH or LCIS from 2000 to 2010. To be included in the study, the case needed to be devoid of additional lesions requiring surgery and have been excised or followed via imaging for a minimum of two years.

Atkins et al identified 50 cases in 49 women. Two breast imagers and a breast pathologist reviewed breast images from the time of the initial biopsy with the core biopsy slides. The findings were concordant in 43 cases. None of these cases were subsequently upgraded to cancer.

Two of the seven discordant cases were upgraded to ductal carcinoma in situ.

The findings suggest that women diagnosed with ALH or LCIS may avoid biopsy in cases of radiologist-pathologist concordance, a change in management that confers both economic and patient care benefits, according to the researchers.

“We have found that if there is comprehensive communication between the radiologist and pathologist, triaging of the biopsy results works well and may save many patients from unnecessary surgery,” wrote Atkins and colleagues. However, the researchers noted the need for further validation of the approach.

“These findings show that some women can avoid surgery, and that yearly mammograms along with MRI or ultrasound as second-line screening tools may suffice,” Michael A. Cohen, MD, professor of radiology at the Emory University School of Medicine in Atlanta, said in the release.