Incidental minimal atypical lobular hyperplasia on core needle biopsy: Correlation with findings on follow-up excision

Andrea Proctor Subhawong, Ty K. Subhawong, Nagi Khouri, Theodore Tsangaris, Hind Nassar

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


INTRODUCTION: Atypical lobular hyperplasia (ALH), often an incidental finding in breast core biopsies, is largely considered to be a risk factor for carcinoma rather than a direct precursor. However, management of ALH is controversial. We review our experience with incidental minimal ALH on core biopsy, and correlate with excision and follow-up results. DESIGN: We evaluated all cases of ALH on core biopsy from 1999 to 2009 from our institution, focusing on cases with ≤3 foci of ALH (minimal), paired excision, and no other lesion on the core biopsy that by itself would require excision. Cases with discordant clinical/radiologic impressions, suggesting that a suspicious lesion had been missed on biopsy, were excluded. Therefore, the excisions were performed because of the diagnosis of ALH. RESULTS: Of 56 cases with ALH on biopsy and paired excision, 42 showed minimal ALH. On excision, 26 had residual ALH and 13 were benign. Three cases had other atypical lesions: lobular carcinoma in situ (2 cases) and mild atypical ductal hyperplasia separate from the biopsy site (1 case). On follow-up, only 1 patient developed subsequent ALH in the same breast. No other ipsilateral lesions were later diagnosed (mean follow-up 3.2 y). CONCLUSIONS: No case with ALH on biopsy had a lesion on excision requiring further treatment, suggesting that these patients can be managed more conservatively. Furthermore, no patients were diagnosed with a higher grade lesion in the same breast on follow-up. We propose that, if there is close radiologic correlation and follow-up, minimal incidental ALH on core biopsy (≤3 foci) does not require excision.

Original languageEnglish (US)
Pages (from-to)822-828
Number of pages7
JournalAmerican Journal of Surgical Pathology
Issue number6
StatePublished - Jun 2010
Externally publishedYes


  • Atypical lobular hyperplasia
  • Core biopsy
  • Excision

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine


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