Lobular neoplasia at percutaneous breast biopsy: Variables associated with carcinoma at surgical excision

OBJECTIVE. The purpose of our study was to better define the rate and variables associated with cancer underestimation when lobular neoplasia is found at minimally invasive breast biopsy. MATERIALS AND METHODS. The records of 32,420 patients who underwent imaging-guided needle biopsy of the breast for mammographic or sonographic abnormalities from 1988 to 2000 were retrospectively reviewed. The 278 cases in which lobular neoplasia was the highest-risk lesion at biopsy were included. Of the 278 cases, 164 proceeded to surgical excision, allowing calculation of rates of underestimation from minimally invasive biopsy. RESULTS. Of the 32,420 minimally invasive breast biopsies, lobular neoplasia was found in 278 (0.9%). One hundred sixty-four of the 278 (59%) continued to surgical excision, where cancer was pathologically confirmed in 38 (23%). No difference was seen in the underestimation rates for lesions diagnosed as lobular carcinoma in situ (25%, 17 of 67 lesions) versus atypical lobular hyperplasia (22%, 21 of 97 lesions). Statistically significant underestimation of carcinoma was found with biopsy of masses (with or without associated microcalcifications) rather than calcifications only, a higher BI-RADS category (p < 0.0001), use of a core biopsy device rather than a vacuum device (p < 0.01), and obtaining fewer specimens (P < 0.0001). CONCLUSION. Significant sampling error occurs regardless of the type of core biopsy device, number of specimens obtained, histologic-radiographic concordance, mammographic appearance, and complete excision of the lesion as determined by imaging. For this reason, all patients with lobular neoplasia at core or vacuum-assisted biopsy should undergo surgical excision until further differentiating criteria can be determined.