The lobular neoplasia enigma: management and prognosis in a long follow-up case series
Abstract Background Many oncologists debate if lobular neoplasia (LN) is a risk factor or an obligatory precursor of more aggressive disease. This study has three aims: (i) describe the different treatment options (surgical resection vs observation), (ii) investigate the upgrade rate in surgically t...
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doaj-54922742df9e4eb0bd342781ae9a7f6b2021-03-21T12:24:40ZengBMCWorld Journal of Surgical Oncology1477-78192021-03-011911810.1186/s12957-021-02182-wThe lobular neoplasia enigma: management and prognosis in a long follow-up case seriesJasna Metovic0Simona Osella Abate1Fulvio Borella2Elena Vissio3Luca Bertero4Giovanna Mariscotti5Manuela Durando6Rebecca Senetta7Ada Ala8Chiara Benedetto9Anna Sapino10Paola Cassoni11Isabella Castellano12Department of Oncology, Pathology Unit, University of TurinDepartment of Medical Sciences, University of TurinDepartment of Surgical Sciences, Gynecology and Obstetrics 1, University of TurinDepartment of Medical Sciences, University of TurinDepartment of Medical Sciences, University of TurinDepartment of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of TurinDepartment of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of TurinDepartment of Medical Sciences, University of TurinBreast Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della ScienzaDepartment of Surgical Sciences, Gynecology and Obstetrics 1, University of TurinDepartment of Medical Sciences, University of TurinDepartment of Medical Sciences, University of TurinDepartment of Medical Sciences, University of TurinAbstract Background Many oncologists debate if lobular neoplasia (LN) is a risk factor or an obligatory precursor of more aggressive disease. This study has three aims: (i) describe the different treatment options (surgical resection vs observation), (ii) investigate the upgrade rate in surgically treated patients, and (iii) evaluate the long-term occurrences of aggressive disease in both operated and unoperated patients. Methods A series of 122 patients with LN bioptic diagnosis and follow-up information were selected. Clinical, radiological, and pathological data were collected from medical charts. At definitive histology, either invasive or ductal carcinoma in situ was considered upgraded lesions. Results Atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and high-grade LN (HG-LN) were diagnosed in 44, 63, and 15 patients, respectively. The median follow-up was 9.5 years. Ninety-nine patients were surgically treated, while 23 underwent clinical-radiological follow-up. An upgrade was observed in 28/99 (28.3%). Age ≥ 54 years (OR 4.01, CI 1.42–11.29, p = 0.009), Breast Imaging-Reporting and Data System (BI-RADS) categories 4–5 (OR 3.76, CI 1.37–10.1, p = 0.010), and preoperatory HG-LN diagnosis (OR 8.76, 1.82–42.27, p = 0.007) were related to upgraded/aggressive disease. During follow-up, 8 patients developed an ipsilateral malignant lesion, four of whom were not initially operated (4/23, 17%). Conclusions BI-RADS categories 4–5, HG-LN diagnosis, and age ≥ 54 years were features associated with an upgrade at definitive surgery. Moreover, 17% of unoperated cases developed an aggressive disease, emphasizing that LN patients need close surveillance due to the long-term risk of breast cancer.https://doi.org/10.1186/s12957-021-02182-wBreastLobular neoplasiaFollow-upUpgradeTreatment |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jasna Metovic Simona Osella Abate Fulvio Borella Elena Vissio Luca Bertero Giovanna Mariscotti Manuela Durando Rebecca Senetta Ada Ala Chiara Benedetto Anna Sapino Paola Cassoni Isabella Castellano |
spellingShingle |
Jasna Metovic Simona Osella Abate Fulvio Borella Elena Vissio Luca Bertero Giovanna Mariscotti Manuela Durando Rebecca Senetta Ada Ala Chiara Benedetto Anna Sapino Paola Cassoni Isabella Castellano The lobular neoplasia enigma: management and prognosis in a long follow-up case series World Journal of Surgical Oncology Breast Lobular neoplasia Follow-up Upgrade Treatment |
author_facet |
Jasna Metovic Simona Osella Abate Fulvio Borella Elena Vissio Luca Bertero Giovanna Mariscotti Manuela Durando Rebecca Senetta Ada Ala Chiara Benedetto Anna Sapino Paola Cassoni Isabella Castellano |
author_sort |
Jasna Metovic |
title |
The lobular neoplasia enigma: management and prognosis in a long follow-up case series |
title_short |
The lobular neoplasia enigma: management and prognosis in a long follow-up case series |
title_full |
The lobular neoplasia enigma: management and prognosis in a long follow-up case series |
title_fullStr |
The lobular neoplasia enigma: management and prognosis in a long follow-up case series |
title_full_unstemmed |
The lobular neoplasia enigma: management and prognosis in a long follow-up case series |
title_sort |
lobular neoplasia enigma: management and prognosis in a long follow-up case series |
publisher |
BMC |
series |
World Journal of Surgical Oncology |
issn |
1477-7819 |
publishDate |
2021-03-01 |
description |
Abstract Background Many oncologists debate if lobular neoplasia (LN) is a risk factor or an obligatory precursor of more aggressive disease. This study has three aims: (i) describe the different treatment options (surgical resection vs observation), (ii) investigate the upgrade rate in surgically treated patients, and (iii) evaluate the long-term occurrences of aggressive disease in both operated and unoperated patients. Methods A series of 122 patients with LN bioptic diagnosis and follow-up information were selected. Clinical, radiological, and pathological data were collected from medical charts. At definitive histology, either invasive or ductal carcinoma in situ was considered upgraded lesions. Results Atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and high-grade LN (HG-LN) were diagnosed in 44, 63, and 15 patients, respectively. The median follow-up was 9.5 years. Ninety-nine patients were surgically treated, while 23 underwent clinical-radiological follow-up. An upgrade was observed in 28/99 (28.3%). Age ≥ 54 years (OR 4.01, CI 1.42–11.29, p = 0.009), Breast Imaging-Reporting and Data System (BI-RADS) categories 4–5 (OR 3.76, CI 1.37–10.1, p = 0.010), and preoperatory HG-LN diagnosis (OR 8.76, 1.82–42.27, p = 0.007) were related to upgraded/aggressive disease. During follow-up, 8 patients developed an ipsilateral malignant lesion, four of whom were not initially operated (4/23, 17%). Conclusions BI-RADS categories 4–5, HG-LN diagnosis, and age ≥ 54 years were features associated with an upgrade at definitive surgery. Moreover, 17% of unoperated cases developed an aggressive disease, emphasizing that LN patients need close surveillance due to the long-term risk of breast cancer. |
topic |
Breast Lobular neoplasia Follow-up Upgrade Treatment |
url |
https://doi.org/10.1186/s12957-021-02182-w |
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