Sandra Brennan MBBCh, MSc, Presenter: Nothing to Disclose

Manuela Durando, Abstract Co-Author: Nothing to Disclose

Adriana D. Corben MD, Abstract Co-Author: Nothing to Disclose

Elizabeth A. Morris MD, Abstract Co-Author: Nothing to Disclose

To evaluate MRI characteristics and upgrade rate to cancer of atypical lobular hyperplasia (ALH) diagnosed at MRI guided vacuum-assisted biopsy (MRI-VAB).

A HIPAA compliant retrospective study was performed by collecting consecutive MRI-VABs yielding ALH between January 2003-December 2012. ALH was divided into 2 groups 1) pure ALH and 2) ALH associated with other high risk lesions (atypical ductal hyperplasia (ADH), papilloma, radial scar or columnar cell changes)(noted ALH/HR). Patients with incomplete data or with synchronous ipsilateral cancer were excluded. ALH that yielded cancer at surgery was defined as upgrade. Statistical analysis was performed (p<0.05) and 95% CI were calculated.

196 consecutive MRI-VABs yielded atypical lesions; 54/196 (27.6%) were ALH. 2/54 cases were excluded for incomplete data and 7/54 for synchronous ipsilateral cancer, leaving 43 patients with 45 ALH (mean size 11.7 mm; range: 3-40). 33/45 (73%) were pure ALH and 12/45 (27%) were ALH/HR (5/45 (11%) associated with ADH. Patients (mean age 53 years; range: 34-72) were predominantly post-menopausal (51.2%), with previous history of breast cancer (41.9%) or high risk lesions (20.9%) and underwent MRI mostly for screening (69.8%). No difference in size, T2 appearance or type of enhancement was noted between pure ALH and ALH/HR. Both pure ALH 24/33 (73%) and ALH/HR 8/12 (67%) showed predominantly progressive kinetics (p=0.95). Surgical excision was performed on 39/45 ALH lesions. The remaining 6/45 lesions underwent imaging follow-up (mean 20 months (range: 12–48)). Malignancy (low grade DCIS) was found in 1/39 (2.6%; CI 95%: 0.1-13.5%) undergoing biopsy or 1/45 (2.2%; CI 95%: 0.1-11.8%) of all cases. The single upgrade occurred in the ALH/HR group associated with ADH. No pure ALH lesions were upgraded at surgery.

ALH represented 27.6% of atypical lesions identified at MRI-guided VABs performed in our high risk population. Upgrade rate to cancer of MRI-VABs yielding ALH was low (2.6% and 2.2%) and was found with ALH associated with ADH only. Pure ALH without associated atypia may not necessitate surgical removal. 

Upgrade rate to cancer of MRI-VABs yielding ALH was low (2.6% and 2.2%) in our study and was found with ALH associated with ADH only, therefore pure ALH without associated atypia may not necessitate surgical removal.

Brennan, S, Durando, M, Corben, A, Morris, E, Atypical Lobular Hyperplasia at MRI Guided Vacuum Assisted Biopsy: Is Surgery Necessary?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013342.html