Study bolsters evidence for surgery recommendation after MRI-diagnosed breast condition

Physicians now have clearer basis for recommending surgical excision for patients in whom magnetic resonance imaging (MRI) detected lobular neoplasia, a known risk factor for developing breast cancer, according to findings reported in Modern Pathology, by researchers at Roswell Park Comprehensive Cancer Center.

When lobular carcinoma is detected by mammography, guidelines regarding other radiological features of the lesion help determine next steps: surgery to remove the lesion versus observation. However, MRI-detected lobular neoplasia, occurs far less commonly and the rate of upgrade to breast cancer is unknown due to the rarity of this scenario. “When clinicians face the diagnosis detected by MRI, they are unable to offer an informative recommendation due to the poor literature,” says lead author Thaer Khoury, MD, FCAP, Associate Professor in the Department of Pathology and Laboratory Medicine at Roswell Park.

Dr. Khoury and Roswell Park’s Prasanna Kumar, MD, Assistant Professor in the Department of Diagnostic Radiology, were able to collect a large number of cases thanks to collaborative work with other institutions including University of Pittsburgh Medical Center, Washington University, and Montefiore Medical Center. They reviewed 1655 MRI-guided core biopsies, yielding 63 cases, the largest known series of lobular neoplasia, to determine the rate of upgrade to invasive carcinoma or ductal carcinoma in situ. They found that one-quarter of the patients would have upgrade when mixed lesions were present and one-third of them when pure lobular neoplasia was found. “Our findings strongly suggest these patients face high enough risk of having concurrent breast cancer; therefore, it is recommended for them to undergo surgical excision,” says Dr. Khoury.

Future research should focus on the MRI morphologic findings and correlate with the upgraded cases in order to subclassify patients who have a higher risk of upgrade than others based on possible specific MRI morphologies.

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