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Watchful Waiting For Some Breast Lesions?

Wed, 07/31/2013 - 10:11am
Crystal Phend

Abnormal lobular tissue in the breast could be safely watched without surgery in selected cases, a small study indicated.

Of 43 cases of atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) where both pathology and radiology agreed it was benign, none were upgraded at surgery or on extended follow-up, Kristen A. Atkins, MD, of the University of Virginia in Charlottesville, and colleagues found.

Out of seven cases with discordant biopsy findings, two (29%) were upgraded to ductal carcinoma in situ at surgery and none on follow-up, the group reported online in Radiology.

The report from Atkins et al. comes a day after a viewpoint article published by the Journal of the American Medical Association made the case for more conservative approaches to many cancers -- including the suggestion that "use of the term 'cancer' should be reserved for describing lesions with a likelihood of lethal progression if left untreated."

In the case of ALH and LCIS, the recommendation has been to perform surgery for all cases, but "when careful radiologic-pathologic correlation is performed and concordance is achieved, women with ALH or LCIS at core biopsy can be observed," Atkins wrote.

If that had been the clinical strategy at the time for these typically incidental findings on core needle biopsy, 86% of the 50 women in the study would have safely avoided a recommendation for excision and 64% of the surgeries that actually were done could have been avoided.

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