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Purpose Classical type of lobular neoplasia (LN) spans a spectrum of disease, including atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), classical lobular neoplasia (LN), and the three-tiered classification of lobular intraepithelial neoplasia (LIN-1, -2, -3). This study addressed inter-observer variability of classical lobular neoplasias (LN) (B3 lesions) in preoperative breast biopsies among breast and gynecopathologists Methods A retrospective, observational, cross-sectional study was conducted. 40 preoperative digital images of breast core/vacuum biopsies were analyzed by eight experienced breast- and gynecopathologists. Evaluation criteria were ALH, LCIS, LN classic, LIN-1, LIN-2, LIN-3, focal B3 (one focus), extensive B3 (> one focus). Kappa-index and Chi-square tests were used for statistics. Digital scanned slides were provided to each participant. Agreement between the categories was defined as at least six of eight (cut-off 75%) concordant diagnoses. Results The highest agreement between eight pathologists was reached using the category lobular neoplasia (LN, classical), 26/40 (65%) cases were diagnosed as such. Agreements in other categories was low or poor: 12/40 (30%) (ALH), 9/40 (22%) (LCIS), 8/40 (20%) (LIN-1), 8/40 (20%) (focal B3), 3/40 (7.5%) (LIN-2), and 2/40 (5%) (extensive B3). Chi-square-test (classical LN versus the other nomenclatures) was significant (p = 0.001137). Conclusion Our data suggest that among Swiss breast pathologists, the most reproducible diagnosis for B3 lobular lesions is the category of classical LN. These data further support lack of consistent data in retrospective studies using different terminologies. Validation of reproducible nomenclature is warranted in further studies. This information is useful especially in view of retro- and prospective data analysis with different diagnostic categories.

Resume Objectif Les neoplasies lobulaires intraepitheliales (NLI) diagnostiquees par biopsie mammaire radioguidee peuvent etre associees a un cancer non diagnostique lors de la biopsie. Dans ce cas, on parle de sous-diagnostic. La prise en charge de ces lesions est par consequent souvent chirurgicale et de nombreuses chirurgies s’averent finalement inutiles. L’objectif de notre travail etait de definir des criteres permettant d’eviter une chirurgie inutile. Materiels et methodes Il s’agit d’une etude monocentrique, retrospective issue d’une base de donnees collectees de maniere prospective. Quatorze mille biopsies ont ete analysees, parmi lesquelles 456 NLI ont ete diagnostiquees. Les taux de sous-diagnostic ont ete analyses en fonction de nombreux criteres. La duree moyenne de suivi etait de 45 mois. Resultats Pour les hyperplasies lobulaires atypiques (HLA), nous avons obtenu 7,6 % de sous-diagnostic et en combinant plusieurs criteres, nous obtenions un risque tres faible de cancer (2 %). Pour les CLIS, ce taux etait de 23 % et aucun sous-groupe a faible risque n’a pu etre identifie. Conclusion Les HLA se traduisant par des microcalcifications ≤ 20 mm, sans autre lesion atypique associee, histologiquement focales et dont l’exerese radiologique est representative peuvent beneficier d’une surveillance clinico-radiologique. Pour les autres lesions de NLI, une chirurgie reste indiquee.

Breast lesions classified as of uncertain malignant potential (B3) on biopsy form a diverse group of abnormalities, which pose a diagnostic and management challenge. In this paper, we discuss the imaging and pathology features as well as the management of the most controversial B3 lesions, consisting of papillary lesions, complex sclerosing lesions/radial scars, lobular intraepithelial neoplasia, and atypical epithelial proliferation of ductal type. As there is an association with malignancy at the time of diagnosis, as well as an increase in the risk of subsequent development of cancer, a multidisciplinary discussion is almost always required to tailor treatment.