[Shall all lobular intraepithelial neoplasia diagnosed on image-guided biopsy require a surgical management?]. / Faut-il opérer toutes les néoplasies lobulaires intraépithéliales diagnostiquées par biopsie mammaire radioguidée ?

OBJECTIVE: Lobular intraepithelial neoplasia (LIN) diagnosed on image-guided biopsy may be associated with an undiagnosed cancer. This is called under-diagnosis. The consequence is that management of these lesions is often surgical. But many surgeries finally are unnecessary. The aim of our study was to define criteria to avoid unnecessary surgery. MATERIALS AND METHODS: This is a single-center, retrospective after a database collected prospectively study. Fourteen thousand biopsies were analyzed, including 456 diagnosed NLI. Under-diagnosis rates were analyzed according to many criteria. The average duration of following was 45 months. RESULTS: For atypical lobular hyperplasia (ALH), we obtained 7.6% under-diagnosis and combining several criteria, we got a low risk of cancer (2%). For LCIS, this rate was 23% and any low-risk group could be identified. CONCLUSION: ALH with calcifications≤20 mm, without any atypical lesion associated, histologically focal and whose removal is representative may be safely observed. For other LIN, surgery remains indicated.

Non-Hodgkin's lymphoma of the breast: a report of 19 cases and a review of the literature.

PURPOSE: Non-Hodgkin's lymphoma of the breast represents 0.04%-0.50% of malignant lesions of the mammary gland. In this article, we report a single institution's experience with this rare disease. MATERIALS AND METHODS: Between 1982 and 1997, 19 patients with breast lymphoma were diagnosed, treated, and followed at this institution. RESULTS: There were 18 female patients and 1 male patient. All but one were cases of aggressive B-cell lymphoma. Ann Arbor stages were IE (n=5), IIE (n=9), IIIE (n=2), and IV (n=3). International Prognosis Index scores were 0 (n=2), 1 (n=8), 2 (n=7), and 3 (n=2). According to the Wiseman and Liao classification established in 1972, 11 cases were primary lymphomas of the breast, and 8 cases were secondary involvement of the breast. Median survival time was 21.5 months (range, 5.1-114.7 months). The 5-year overall survival was 29%. Median event-free survival time was 8.3 months. The clinical, radiologic, and histologic patterns of presentation match previously published data, even if the response rates and the survival times seem disappointing, probably because of the initial treatment by tumorectomy or mastectomy for some patients. CONCLUSIONS: Systemic chemotherapy should be the mainstay of treatment. Based on our experience and a review of the literature, the use of Wiseman and Liao's classification is questionable. In fact, it fails to detect whether some lymphomas of the breast present a specific natural history and therefore require specific management. New clinical and histologic criteria are to be identified.