The radiological features, diagnosis and management of screen-detected lobular neoplasia of the breast: Findings from the Sloane Project

• Published in: Breast (Edinburgh) Vol. 27; pp. 109 - 115
• Main Authors: Maxwell, Anthony J., Clements, Karen, Dodwell, David J., Evans, Andrew J., Francis, Adele, Hussain, Monuwar, Morris, Julie, Pinder, Sarah E., Sawyer, Elinor J., Thomas, Jeremy, Thompson, Alastair
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2016
• Subjects: Aged; Atypical lobular hyperplasia; Breast - diagnostic imaging; Breast - pathology; Breast cancer; Breast Carcinoma In Situ - diagnostic imaging; Breast Carcinoma In Situ - pathology; Breast Carcinoma In Situ - surgery; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Calcinosis - diagnostic imaging; Calcinosis - pathology; Early Detection of Cancer - methods; Female; Hematology, Oncology and Palliative Medicine; Humans; Lobular carcinoma in situ; Lobular neoplasia; Mammography; Mammography - methods; Mastectomy; Middle Aged; Prospective Studies; Screening; Unilateral Breast Neoplasms - diagnostic imaging; Unilateral Breast Neoplasms - pathology; Unilateral Breast Neoplasms - surgery; United Kingdom; Lobular neoplasia; Screening; Breast cancer; Mammography; Lobular carcinoma in situ; Atypical lobular hyperplasia
• ISSN: 0960-9776; 1532-3080
• DOI: 10.1016/j.breast.2016.03.004

To investigate the radiological features, diagnosis and management of screen-detected lobular neoplasia (LN) of the breast. 392 women with pure LN alone were identified within the prospective UK cohort study of screen-detected non-invasive breast neoplasia (the Sloane Project). Demography, radiological features and diagnostic and therapeutic procedures were analysed. Non-pleomorphic LN (369/392) was most frequently diagnosed among women aged 50–54 and in 53.5% was at the first screen. It occurred most commonly on the left (58.0%; p = 0.003), in the upper outer quadrant and confined to one site (single quadrant or retroareolar region). No bilateral cases were found. The predominant radiological feature was microcalcification (most commonly granular) which increased in frequency with increasing breast density. Casting microcalcification as a predominant feature had a significantly higher lesion size compared to granular and punctate patterns (p = 0.034). 326/369 (88.3%) women underwent surgery, including 17 who underwent >1 operation, six who had mastectomy and six who had axillary surgery. Two patients had radiotherapy and 15 had endocrine treatment. Pleomorphic lobular carcinoma in situ (23/392) presented as granular microcalcification in 12; four women had mastectomy and six had radiotherapy. Screen-detected LN occurs in relatively young women and is predominantly non-pleomorphic and unilateral. It is typically associated with granular or punctate microcalcification in the left upper outer quadrant. Management, including surgical resection, is highly variable and requires evidence-based guideline development. •Non-pleomorphic lobular neoplasia is typically left-sided and unilateral.•In many cases it develops before the menopause.•It is commonly associated with granular microcalcification•Management is highly variable and surgical treatment often excessive.•Evidence-based management guidelines are required.