How is lobular neoplasia managed?

The management has evolved over time from bilateral mastectomy (due to future risk), excisional biopsy (due to potential upgrade to breast cancer) and imaging follow-up (since risk for cancer is observed away from site of biopsy). Current recommendations for excision or imaging follow-up depend on radiology-pathology concordance and method of detection.
For instance, when incidental on pathology and other histology present on H&E is concordant for the imaging-finding targeted for biopsy, lobular neoplasia can be followed with imaging. However, when identified by MRI, excision is currently recommended.
Given risk of future breast cancer, referral for high-risk assessment is suggested for all patients with lobular neoplasia.