A new study has reported that there is a significant underestimation of invasive breast cancer in patients diagnosed with lobular neoplasia (lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia) based on core needle biopsy. To conduct the study, the authors searched medical databases to identify and review all English-language articles addressing the management of lobular neoplasia diagnosed on core needle biopsy. Studies concerning mixed breast cancer types were excluded. The study included a total of 1,229 lobular neoplasia lesions diagnosed on core needle biopsy, of which 789 (64%) cases subsequently underwent open surgical biopsy. A total of 280 of the 789 were classified as atypical lobular hyperplasia, 241 as LCIS, 22 as pleomorphic LCIS and 246 unspecified LCIS based on the original core needle biopsy.

However, 211 (27%) of the 789 cases were found to contain either DCIS or invasive breast cancer after open surgical biopsy of the tumor: 19% of the atypical lobular hyperplasia cases, 32% of the LCIS cases, and 41% of the pleomorphic LCIS cases contained malignancy. In addition, 29% of the unspecified LCIS cases were upgraded to invasive breast cancer. The authors conclude that there is a significant underestimation of malignancy in patients diagnosed with lobular neoplasia on core needle biopsy; 27% were found to contain invasive breast cancer following surgical excision. All patients diagnosed with lobular neoplasia based on core needle biopsy should be considered for surgical excision biopsy, according to the authors.

Please see our article on lobular breast cancer and LCIS for more information.