Some Abnormal Breast Lesions May Not Require Surgery

Women with atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) may not always require surgery, according to a study published in the journal Radiology.

ALH and LCIS are abnormal breast lesions that may appear as incidental findings in breast biopsies. Women with ALS or LCIS do have a four to 10 times higher risk of developing breast cancer, but results of a study by researchers from Emory University School of Medicine in Atlanta, Ga, and the University of Virginia in Charlottesville, say that watchful waiting may be sufficient for most patients.

“From a pathology perspective, ALH and LCIS are often very tiny lesions, so we wondered why they were getting excised,” researcher Kristen Atkins, MD, said in a release. “These surgeries may involve general anesthesia and possible disfigurement.” Atkins is a pathologist and associate professor at the University of Virginia.

The researchers studied 50 cases from 49 women, aged 40 to 73. They reviewed the pathology and radiology data for correlations between the number of ALH and LCIS that were upgraded to cancer after surgery or follow up and the concordance between the radiologist and pathologist. The researchers found that radiologist and pathologist findings were concordant in 43 of the cases. No benign concordant case was subsequently upgraded to cancer. Of the seven discordant cases, two were upgraded to ductal carcinoma in situ (DCIS).

Michael A. Cohen, MD, PFACR, who conducted this study with Atkins, repeated the study and came up with the same results. Cohen is a professor of radiology at Emory University. “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,” he said.