Lobular Neoplasia Atypical Lobular Hyperplasia Lobular Carcinoma Insitu

First described in 1941, this series of characteristic lesions have had perceptions of their implications changed frequently. The lobular neoplasia series includes lesions identified as atypical lobular hyperplasia (ALH) and lobular carcinoma in-situ (LCIS) with some variety of individual authors using different terms and concepts. However, in studies rigorously performed with specific criteria, the ALH lesion (21) is both dominant and best studied using specific criteria. With more extensive density of local disease, LCIS has a slightly greater increased risk that may not be of great clinical importance (22).

While ALH has been long considered a risk indicator along with LCIS, it is now quite evident that subsequently developing carcinomas tend to be regional, favoring the breast in which the ALHs was originally diagnosed (23) rather than the model for clinical-decision making accepted for many years which was one ofequal risk of later cancer in each breast. Studies by Rosen, et al. published in 1981 (24), showed a very low risk for later invasive carcinoma in the contralateral risk of women with LCIS, especially ofbiopsy samples taken from the contralateral breast had shown no lobular neoplasia. Also, Page, et al. demonstrated that after ALH, 70% of subsequent invasive carcinomas develop in the same breast with only 30% in the contralateral breast (23). There is a favored association of these later carcinomas having lobular and tubular features, but this association is not terribly strong (22). However, the association of the type of invasive carcinoma having some lobular features further support that the ALH lesions and LCIS are true precursors with a model certainly intermediate between general increased risk of ADH and most risk indicators, and local increased risk precursor model evidenced by DCIS.

Table 2. Relative Risk of Invasive BC After Biopsy. Follow-up 10 Years After Initial Biopsy, Compared to Similar Women of Similar Age.*

Nashville

Cohort Study

Proliferative Breast Disease

(PBD) Without Atypia Atypical Hyperplasia

(both ADH and ALH combined)

1.6 to 2.3 3.1 to 8.8

Harvard Nurses' Study Case Control Design

PBD Without Atypia Atypical Hyperplasia

1.2 to 2.2 2.6 to 5.9

BCDDP

Case Control Design Specific Histologic Review

PBD Without Atypia Atypical Hyperplasia

0.77 to 2.2 1.7 to 11.0

BCDDP

Review of Original Pathology reports

*95% confidence interval

*95% confidence interval

Precursors and increased BC risk markers are usually considered as quite separate elements. However, it is quite evident that if one has many individual lesions with low but greater risk than normal tissue that, as a practical matter, multiple increased risk lesions may actually serve more as markers ofincreased risk as a practical matter than precursors. Thus, the magnitude of increased subsequent risk of individual lesions as well as their numbers and distribution in the breast become important considerations (23). The various lesions with risk implications also have important variations in incidence related to age and reproductive factors (25).

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