What is the preferred mode of action for patients with Lobular Neoplasia: surgery or observation?

The present study tested whether Lobular Neoplasia (LN) diagnosed on Core Needle Biopsy (CNB) leads to breast cancer and if a selected group of patients can be safely observed rather than treated early. The main findings were that not all patients with LN diagnosed on CNB need surgery (excision).

Breasts are made up of lobules (milk-producing glands) and ducts (tubes that carry the milk to the nipple) surrounded by glandular and fatty tissue. Lobular neoplasia means that there are abnormal changes in the breast lobules. These include conditions like Atypical Lobular Hyperplasia (ALH) and Lobular Carcinoma in Situ (LCIS). LN in not breast cancer, but it can be considered a marker (signal) of an increased risk for developing breast cancer in the future, or ‘pre-cancerous lesion’. This is why current guidelines recommend surgery (local excision of the lesion) to rule out cancer. Because most LN patients do not develop breast cancer, this study aimed to see if there is a subgroup of patients with LN that can be safely observed instead of operated.

LN is difficult to diagnose, as most women do not have any symptoms. It is usually discovered through a Core Needle Biopsy or CNB (breast tissue sample collected using a needle) performed for a breast lump or a calcification (small calcium spot) on a mammogram (breast x-ray).

The study included 184 cases of LN (147 ALH and 37 LCIS) diagnosed on CNB between January 1993 and December 2010. Surgery (excision) was performed in 55% of cases and the other 45% were observed. Patients were followed-up for an average of 50.3 months. Among the excised cases, only 1.2% of ALH and 5% of LCIS actually had breast cancer in the same breast. Of the cases observed, 2% of ALH and 21.4% of LCIS developed breast cancer. During follow-up, only 2.9% of all patients (excised or observed) developed breast cancer in the other breast.

In summary, the study found that not all patients with lobular neoplasia diagnosed on CNB need surgery. Patients with pure ALH, without other abnormal changes in the biopsy or on the mammogram, can be safely observed. Patients with LCIS more often develop breast cancer and thus may require surgical excision following CNB.

Careful follow-up is required for all LN patients because they have an increased risk of developing cancer in either breast.

You should carefully discuss LN treatment options with your doctor to determine if surgery is required.