Breast Lesions of Uncertain Malignant Potential: A Challenge for Surgeons

Lobular neoplasia, radial scar and atypical ductal hyperplasia on core needle biopsy pose a challenge for surgeons. We looked at upgrade rates for these lesions to determine which should be excised. We found that lobular carcinoma in situ and atypical ductal hyperplasia had to be operated and that radial scar and atypical lobular hyperplasia could be observed. Objective and background: The need for surgical resection of breast lesions of uncertain malignant potential diagnosed by core-needle biopsy (CNB) is not well established. Our study sought to determine the incidence of these lesions at CNB and to find the rate of pathologic upgrade at surgery. and during clinical follow-up. Method: A retrospective review of CNBs performed at our hospital covering the period from November 1999 to December 2008 was undertaken. In those patients diagnosed with lobular neoplasia (atypical lobular neoplasia (ALH) and lobular carcinoma in situ (LCIS)), atypical ductal hyperplasia (ADH) and radial scar (RS) the rates of pathologic upgrade at subsequent surgery were determined. Results: 9325 breast CNBs were performed during the period under review. There were 36 diagnoses of ALH (0.4%), 20 of LCIS (0.2%), 110 of ADH (1.2%) and 60 of RS (0.6%). Regarding lobular neoplasia, ALH surgical resection was performed with subsequen