Effect of breast core needle biopsy technique on detection of lobular intraepithelial neoplasia.

OBJECTIVE: Lobular intraepithelial neoplasia-atypical lobular hyperplasia and lobular carcinoma in situ-is a noninvasive breast lesion occasionally found in core needle biopsy and surgical biopsy specimens. The objective of this study is to identify the increased incidence of lobular carcinoma in situ with current stereotactic biopsy techniques.
METHODS: Biopsy results from 1993 to 2004 were reviewed retrospectively. 2,940 stereotactic biopsies were performed using a 14-gauge gun-type needle; 1,807 stereotactic biopsies were performed using an 11-gauge vacuum-assisted needle; and 2,724 ultrasound-guided biopsies were performed using a 14-gauge gun-type needle.
RESULTS: The incidence of lobular intraepithelial neoplasia was 0.4% using the stereotactic 14-gauge technique, 0.4% using the ultrasound-guided 14-gauge technique, and 1.7% using the 11-gauge stereotactic technique. The increased rate of detection of lobular carcinoma in situ with an 11-gauge needle was statistically significant (p<.0001).
CONCLUSION: Lobular intraepithelial neoplasia is believed to be an incidental finding without specific imaging or clinical characteristics. Patients with detected lobular intraepithelial neoplasia have a significantly increased risk for subsequently developing breast cancer. Management recommendations can include no treatment, local excision, chemoprevention, and even bilateral prophylactic mastectomy. Radiologists and referring physicians need to be aware of the wide-ranging treatment recommendations, as lobular intraepithelial neoplasia is being identified more frequently.