Lobular neoplasia detected at MRI-guided biopsy: imaging findings and outcomes

• Published in: Clinical imaging Vol. 78; pp. 171 - 178
• Main Authors: Chikarmane, Sona A., Harrison, Beth T., Giess, Catherine S., Pinkney, David M., Gombos, Eva C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2021; Elsevier Limited
• Subjects: Atypical lobular hyperplasia; Biopsy; Breast; Breast cancer; Breast MRI; Histopathology; Hyperplasia; Liver cancer; Lobular carcinoma in situ; Lobular neoplasia; Magnetic resonance imaging; Malignancy; Mammography; Medical imaging; Medical records; MRI-guided biopsy; Pathology; Population studies; Radiology and pathology correlation; Statistical analysis; Ultrasonic imaging; Lobular neoplasia; Breast MRI; MRI-guided biopsy; Radiology and pathology correlation; Lobular carcinoma in situ; Atypical lobular hyperplasia
• ISSN: 0899-7071; 1873-4499
• DOI: 10.1016/j.clinimag.2021.03.026

To review MRI findings of pure lobular neoplasia (LN) on MRI guided biopsy, evaluate surgical and clinical outcomes, and assess imaging findings predictive of upgrade to malignancy. HIPAA compliant, IRB-approved retrospective review of our MRI-guided breast biopsy database from October 2008–January 2015. Biopsies yielding atypical lobular hyperplasia or lobular carcinoma in situ were included in the analysis; all biopsy slides were reviewed by a dedicated breast pathologist. Imaging indications, MRI findings, and histopathology were reviewed. Statistical analysis was performed using the two-tailed Fisher exact-test and the t-test, and 95% CIs were determined. A p < 0.05 was considered statistically significant. Database search yielded 943 biopsies in 785 patients of which 65/943 (6.9%) reported LN as the highest risk pathologic lesion. Of 65 cases, 32 were found to have LN as the dominant finding on pathology and constituted the study population. All 32 findings were mammographically and sonographically occult. Three of 32 (9.3%) cases of lobular neoplasia were upgraded to malignancy, all LCIS (one pleomorphic and two classical). The most common MRI finding was focal, heterogenous non-mass enhancement with low T2 signal. No clinical features or imaging findings were predictive of upgrade to malignancy. Incidence of pure lobular neoplasia on MRI guided biopsy is low, with comparatively low incidence of upgrade to malignancy. No imaging or clinical features are predictive of upgrade on surgical excision, therefore, prudent radiologic-pathologic correlation is necessary. •Incidence of pure lobular neoplasia (LN) detected on MRI-guided breast biopsies is low (3.4%).•Pure LN may present as focal, heterogenous non-mass enhancement with low T2 signal.•Prudent radiologic-pathologic correlation and evaluation of risk factors is required to determine appropriate management.