Path Report Help... atypical lobular hyperplasia

shabby6485

Hi again,

After an excision biopsy, path reads microfocus of atypical lobular hyperplasia.  I need to go for a 6 mos. mammo. 

When they do the exisional, do they take out the alh? 

Worried!

GayleB

I had atypical cells, too, along with ILC.  I had the needle biopsy using an ultrasound.  They didn't get the entire mass of atypical cells, only a portion of it.  But, I can't say for sure what your dr did.  You really should call and clarify with them.  After all, that's what you pay for!  At any rate, with atypical cells, they generally choose the watch and wait approach.  For me, since they found the ILC (quite by accident, I might add), I went for the bi-lateral mast and just got it over with then.  Good luck.

Beesie

Atypical cells don't really need to be removed, although often they are removed.  The reason is not a problem with the atypical cells but a concern that something else might be lurking.  Since you had an excisional biopsy rather than just a needle biopsy, it suggests that all or most of your atypical cells were removed, and, the good news, nothing more serious was found.

As for whether all your ALH cells were removed, do you have a copy of the pathology report?  It might mention the margins.  The margin is the area around the edge of the removed tissue.  It may say that the sample had "clean margins" around it - that would mean that no ALH was found at the edges and that would suggest that all the ALH was removed.  Or it might specify the size of the margins (3mm or 0.5cm or something like that) - that would indicate the amount of breast tissue at the edge of the sample with no ALH found in it.  Again, that would suggest that all the ALH was removed.  If it says that ALH cells were found "in the margins", that would mean that there may be some ALH cells left in your breast.  But again, even if that's the case, with ALH that's not considered a problem.

leaf

Hi there!  I have ALH, and LCIS, which is a more advanced form of ALH. 

Bessie is right in that they do the excisional to see if there is 'something worse' around the area where the ALH was found.

However, ALH and LCIS are often multifocal and bilateral (meaning they often find multiple spots of ALH in one breast, and they often find it in both breasts.)  http://www.ncbi.nlm.nih.gov/pubmed/9788628 

 Since LCIS and ALH are normally only detectable by biopsy (and not imaging or clinical exam), how would they know this?  Up until about the mid-1990s, they used to routinely do prophylactic bilateral mastectomies for LCIS patients. 

But it doesn't really matter if they removed all of ALH or LCIS.  That's because it seems like even if you are in the minority and only have one spot of ALH or LCIS in one breast, and the other breast is perfectly normal, the ALH or LCIS seems to put BOTH breasts at risk.  Its a weird condition.  

Since the only true way they have of finding ALH is by looking at cells under the microscope, they can't know if they removed ALL of the ALH unless they did a mastectomy. Even when they do mastectomies, they cannot remove 100% of breast tissue.

Gayle is right: for atypia and nothing worse, they generally do a wait and watch approach.  Your options may change if you have a bad family history, such as are positive for a BRCA mutation.

Your risk may be lower than what you think.  These statistics may not be very valid for you as an individual, but for people who are like you, you may get some idea of your risk by using the Gail model. http://www.cancer.gov/bcrisktool/ 

GayleB

leaf, thanks for the response--it was much more informative and in-depth than mine.  My atypical is the one that showed on the mammography--the ILC was discovered when the tech was setting up the u/s for the biopsy.  I thank God every day for that tech and her diligence--she probably saved my life.  I didn't have anything in the other breast, but I went the bi-lat route for my own peace of mind--made absolute perfect sense to me.  But, every one of us has to decide for ourselves.  Anyway, I am so comfortable with the decision and the reconstruction is done.  I am now in the process of getting back to my life.