More About Lobular Neoplasia
Lobular Neoplasia describes a histological finding of unexpected new cell growth in the breast lobules. A discovery of lobular neoplasia is quite unexpected, and there is some difference in opinion as to whether or not lobular neoplasia presents a serious breast cancer threat requiring aggressive action.
Follow-up Surgical Excision or FSE
Among the management options for Lobular Neoplasia is the follow-up surgical excision (FSE) of a given lesion or mass. This is not without controversy. Some experts point to the historical tendency to underestimate the malignancy of core needle samples (suggested to occur about 18% of the time), and thus it is prudent to remove additional breast tissue every time. Other factors might be increased risk factors such as a radial scar, papillary lesions, atypical ductal hyperplasia, and microcalcifications.
Lobular neoplasia is generally a favorable diagnosis
Lobular Neoplasia is felt have a slightly greater tendency toward malignancy when compared to ductal neoplasia. But generally speaking the discovery of lobular neoplasia is felt to be a fortuitous diagnosis.
Lobular Neoplasia is often considered a risk marker only
A majority of oncologists tend to view Lobular Neoplasia as a ‘risk marker‘ only and not a carcinoma, so surgical excision would seem unnecessary. Often an intitial finding of Lobular Neoplasia does not suggest a definitive course of action, so a prudent physician might suggest a FSE a few months later, both to check for progress and to remove potentially malignant breast tissue. Consider your own anxiety level and accompanying factors.
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Below are a couple common Q&A…
- What is the meaning of lobular NEOplasia? When this occurs, there is an increase in the number of cells contained in the lobules, together with a change in their appearance and behavior.
- How is lobular neoplasia diagnosed? It can be difficult to diagnose because most women with lobular neoplasia have no symptoms. It is usually diagnosed after a biopsy is done on the breast for some other reason, such as an abnormal finding on a mammogram or a suspicious breast lump. These procedures may include fine need aspiration biopsy, core needle biopsy, incisional biopsy, or excisional biopsy.
- What are the treatment options for lobular neoplasia? Close monitoring (regular clinical exams, regular screening mammography, MRI, and monthly breast self-exams), hormone therapy medicines (such as tamoxifen, raloxifene, exemestane, and anastrozole have been shown to reduce breast cancer risk), and risk-reducing surgery (prophylactic mastectomy). Also, you may want to consider taking part in a clinical trial that is testing a new approach to reducing the risk of breast cancer.
- Cohen MA. Cancer Upgrade at Excisional Biopsy after Diagnosis of Atypical Lobular Hyperplasia or Lobular Carcinoma in Situ at Core-Needle Biopsy: Some Reasons Why. Radiology 2004; 231: 617-621.
- Elsheikh TM, Silverman JF. Follow-up Surgical Excision is Indicated when Breast Core Needle Biopsies Show Atypical Lobular Hyperplasia or Lobular Carcinoma in Situ. Am. J. Surg. Pathol. Volume 29, Number 4, April 2005.
- Lakhani SE. In Situ Lobular Neoplasia: time for an Awakening. Lancet 2003; 361: 96.
- Hwang, H., Sullivan, ME., Susnik, B. Lobular neoplasia. Diagnositic Histopathy. (July 2010) Volume 16, Issue 7, Pages 337-344