Some Abnormal Breast Lesions May Not Require Surgery

Surgery is not always necessary for women with atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), abnormalities commonly associated with a higher risk of cancer, according to a new study.

Researchers at Emory University (Atlanta, GA, USA) and the University of Virginia (Charlottesville, USA) studied 10 years of pathology and radiology data to look for a correlation between the number of ALH and LCIS cases that were upgraded to cancer after surgery or follow up, and the concordance between the radiologist and pathologist. The research yielded 50 cases from 49 women aged 40-73 years, with radiologist and pathologist findings were concordant in 43 of the 50 cases.

None of the benign concordant cases were subsequently upgraded to cancer, strongly suggesting that observation in these patients would have been a viable alternative to surgery. Of the seven discordant cases, two were upgraded to ductal carcinoma in situ (DCIS), an early-stage, noninvasive form of breast cancer. The researchers concluded that periodic imaging and clinical examination are effective in these patients when radiology and pathology findings are benign and concordant. The study was published online ahead of print on July 30, 2013, in Radiology.

“When there’s no discordance between the radiologist and pathologist after thorough radiology-pathology correlation, there’s no upgrade from ALH or LCIS to cancer in our study,” said professor of radiology Michael Cohen, MD. “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.”

ALH occurs in the epithelial cells lining of the milk lobes, producing more cells than would normally grow there. Usually, a lobe is lined with one even layer of uniformly shaped cells, but in lobular hyperplasia there may be several layers of cells. Atypical lobular cells can potentially develop into LCIS, a noninvasive form of breast cancer. Women with ALH or LCIS have a 4 to 10 times higher risk of developing breast cancer.


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Emory University

University of Virginia