When Should You Have an Open Excisional Biopsy?

For a long time now, it has been the standard of care to do an open excisional biopsy if atypical duct hyperplasia (ADH) is found on a core or stereotactic biopsy. An open excisional biopsy involves surgically removing and analyzing a larger area of tissue than is possible with other biopsies. Now new research tells us that women with other high-risk conditions like LCIS (lobular carcinoma insitu) and ALH (atypical lobular hyperplasia) also should have open excisional biopsies to double check for the presence of cancer.

In a new study published in the November issue of American Journal of Surgery, doctors at Washington University School of Medicine in St. Louis looked at medical records of women whose initial core-needle breast biopsies found ALH or LCIS. Like ADH, these findings mean that there is a high risk of cancer but none of them are a diagnosis of cancer. That's why more tissue is needed to determine if cancer already exists in the area where the high-risk cells were found.

What surprised the researchers was that up to 25 percent of the women who had follow-up open excisional biopsies actually had cancer in addition to their high-risk breast conditions. Most of these cancers were invasive, meaning the tumors had penetrated normal breast tissue and would require treatment with surgery and adjuvant therapy. None of the tumors had spread beyond the breast.

"This is very significant," explains lead author Julie A. Margenthaler, M.D. "We now know that we can't assume that women with ALH or LCIS are cancer-free."

LCIS and ALH are known to increase the risk of breast cancer but neither is considered a pre-cancerous condition. According to Margenthaler, together these conditions represent only about one percent of all breast lesions. "This seems like a small number but with more than 100,000 core-needle breast biopsies performed in the United States each year, the number of potential cancers missed by not doing a more extensive follow-up biopsy is sizeable," she says.

The cancers detected in the study were too small to be felt by a woman or her doctor.

If you have had a core biopsy and were told that the findings were "benign," ask for a copy of the pathology report to ensure that ALH or LCIS wasn't found within the specimen. If one of these conditions was found, then it's time to consult a surgeon who specializes in breast cancer surgery for additional tissue sampling. This way you won't fall into the 20 percent of women with these conditions who already have cancer.


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