Lobular Neoplasia has been stratified by cytology and/or distension-distortion of lobular units. But, atypical lobular hyperplasia ( ALH) is uniformly accepted and utilized in the Vanderbilt, Mayo and Harvard follow-up studies ( see references) .
We as well as all other groups that have provided follow up studies for lobular premalignant disease since 1990, use consistent histologic criteria for the diagnosis of atypical lobular hyperplasia (ALH) which recognizes the great majority of lesions in this cytologic series that includes lobular carcinoma in situ. The lesser or minimal examples of lobular disease are dominant in the post-menopausal age group in whom breast cancer risk is not significantly altered by the presence of atypical lobular hyperplasia.
A few cases with lobular cytology that have marked distension, distortion and many cellular lesions in a breast have provided some variety of descriptive approaches to these lesions. We believe that the cytologic variability does not well reflect the extensiveness of the lesions. Considering that the molecular biology studies have indicated that these lesions are pre-cursors, we think that risk really depends upon the number and density of these lesions. These unusually dense lesions are rightfully termed lobular carcinoma in situ.
Atypical lobular hyperplasia is now well known to most often be dominant in one breast as opposed to the other and considerations of debulking dense disease have been now considered. We and many others take the approach that a “tumor forming” variant of lobular carcinoma in situ, the more severe presentations of lobular disease should be recognized with fairly broad confines of definition and that such lesions should probably be excised to less dense disease with considerations at that point given to the possibility of anti-estrogen preparations for prevention.
We have in press, in the journal, Cancer, "Excellent Survival, Cancer Type, and Nottingham Grade following Atypical
Lobular Hyperplasia on Initial Breast Biopsy" (McLaren, et al) our follow-up of 250 patients with atypical lobular hyperplasia reported in the 2003 article in Lancet ( see references) with regard to laterality.
The likelihood of death from the invasive cancers in these patients is remarkably low and most of the carcinomas that develop are estrogen-receptor positive and low grade. With thirty years follow up after diagnosis of atypical lobular hyperplasia, only eleven women died of breast cancer. Many of these were delayed more than ten years after diagnosis.
Thus, with mammographic surveillance, the cancer deaths will be further reduced.
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3. Page, D.L., Kidd, T.E., Jr., Dupont, W.D., Simpson, J.F., and Rogers, L.W.: Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum. Pathol. 22:1232-1239, 1991.
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6. Page, et. al. “Atypical Lobular Hyperplasia As A Unilateral Predictor of Breast Cancer Risk: A Retrospective Cohort Study.” The Lancet; 2003; 360: 125-129.
7. McLaren, B. K., Schuyler, P. A., Sanders, M. E., Jensen, R. A.,
Simpson, J. F., Dupont, W. D., and Page, D. L. Excellent survival, cancer
type, and Nottingham grade after atypical lobular hyperplasia on initial
breast biopsy. Cancer, 2006
