The lobular neoplasia enigma: management and prognosis in a long follow-up case series

World J Surg Oncol. 2021 Mar 18;19(1):80. doi: 10.1186/s12957-021-02182-w.


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.

Keywords: Breast; Follow-up; Lobular neoplasia; Treatment; Upgrade.

MeSH terms

  • Breast Neoplasms* / diagnostic imaging
  • Breast Neoplasms* / epidemiology
  • Breast Neoplasms* / surgery
  • Carcinoma in Situ*
  • Carcinoma, Lobular* / diagnostic imaging
  • Carcinoma, Lobular* / surgery
  • Follow-Up Studies
  • Humans
  • Hyperplasia
  • Middle Aged
  • Prognosis