Some women with abnormal breast lesions may avoid surgery

Surgery is not always necessary for women with a type of breast tissue abnormality associated with a higher risk of cancer, according to a study published online July 30 in Radiology.

Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) are abnormal breast lesions that can appear as incidental findings in breast biopsies. Women with these lesions have a four to 10 times greater risk of developing breast cancer, according to Dr. Michael Cohen, from Emory University School of Medicine, and colleagues.

These lesions are usually excised; however, the researchers found that periodic imaging and clinical exams are effective in these patients when radiology and pathology findings are benign.

The team examined 10 years of pathology and radiology data, looking for correlations between the number of ALH and LCIS cases that were upgraded to cancer after surgery or follow-up, and whether the radiologist and pathologist agreed on the results. Fifty cases from 49 women were included in the study, and radiologist and pathologist findings were concordant in 43 of the 50 cases.

None of the benign concordant cases were upgraded to cancer, which suggests that observing these patients would have been a viable alternative to surgery, the study group concluded. Of seven discordant cases, two were upgraded to ductal carcinoma in situ, an early-stage, noninvasive form of breast cancer.