ABSTRACT
A 56-year-old female was recalled for assessment following screening mammography that demonstrated a new 9-mm indeterminate density in the left breast. Clinical breast examination was normal. Ultrasound confirmed a 9-mm predominantly well-defined hypoechoic breast mass. Core biopsy demonstrated large histiocytes with emperipolesis and positive staining for S100, which is consistent with Rosai-Dorfman disease (RDD). Multidisciplinary team discussion concluded case concordance. The patient was discharged back to the screening programme. RDD is a rare, benign condition that may mimic breast cancer. This case demonstrates that identification of RDD on core needle biopsy may help avoid unnecessary surgery.
ABSTRACT
OBJECTIVES: To audit the outcomes of patients with non-pleomorphic lobular in situ neoplasia (LISN) of the breast and clarify the role of vacuum-assisted biopsy (VAB), surgical biopsy and conservative management for this condition. MATERIALS AND METHOD: A single-centre retrospective review of hospital databases covering a 14-year period was performed. Patients with LISN as the most pertinent diagnosis on core needle biopsy (CNB), vacuum-assisted biopsy (VABs) or surgical biopsy were identified. The radiological features, histopathological findings and outcome of subsequent annual mammography were recorded. RESULTS: Between 1998 and 2012 there were 70 patients with LISN as the most pertinent diagnosis at CNB, VAB or surgery. 52 underwent VAB, typically 18 11-gauge samples. The pathology was upgraded from the preceding 14-gauge CNB in 7 cases. Of 11 patients who underwent surgery after VAB, one (who had undergone a low tissue yield VAB) was upgraded. There were no new breast cancers during a mean annual mammographic follow-up period of 53 months in 40 patients who had VAB with complete radiological-histopathological concordance. CONCLUSION: Provided there is adequate tissue sampling and radiological-pathological concordance, VAB is a safe alternative to open biopsy in the management of non-pleomorphic LISN.