Atypical Lobular Hyperplasia of the Breast
Clinical
- Atypical lobular hyperplasia is a marker of increased risk of carcinoma to both breasts but it is uncertain whether it is also a preinvasive lesion
- The most recent evidence suggests ALH in a core biopsy is an indication for excision particularly if it is extensive
- We particularly consider its presence in a core biopsy to be an indication for excisional biopsy in the following situations:
- If there is discordance between the mammographic and pathologic findings
- If another lesion such as atypical ductal hyperplasia is present
- If the lobular nature of the cells is at all equivocal
- In an excisional biopsy, margins are not relevant if it is the only lesion unless the process is extensive
Relative risk for development of invasive breast carcinoma
- No increased risk
- Non-proliferative fibrocystic change
- Fibroadenoma
- Solitary papilloma
- Slightly increased risk (1.5 to 2 times)
- Proliferative fibrocystic change
- Usual ductal hyperplasia
- Sclerosing adenosis (florid)
- Radial scar
- Complex fibroadenoma (approximately 3 times risk)
- Moderately increased risk (4 to 5 times)
- Atypical ductal hyperplasia (no family history)
- Atypical lobular hyperplasia
- High risk (8 to 10 times)
- Ductal carcinoma in situ, low grade
- Lobular carcinoma in situ
- Atypical ductal hyperplasia, if history of carcinoma in primary relatives
- Very high risk (precise level not known)
- Ductal carcinoma in situ, high grade
