Clinical and pathologic correlation with mammographic findings in lobular carcinoma in situ

Hutter, R. V. P.; Snyder, Ruth E.; Lucas, John C.; Foote, Frank W.; Farrow, Joseph H.

doi:10.1002/1097-0142(196904)23:4<826::aid-cncr2820230417>3.0.co;2-p

Cited by 79 publications

(15 citation statements)

References 8 publications

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“…At variance with previous works on histologically proven cases of LCIS, where review of the mammographic findings demonstrated only nonspecific mammographic abnormalities [10,11,17], all our cases showed calcifications histologically located within the neoplastic lobules.…”

Section: Discussioncontrasting

confidence: 96%

Mammographically detected in situ lobular carcinomas of the breast

Sapino

Frigerio²,

Peterse³

et al. 2000

Virchows Archiv

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We present ten cases of mammographically detected lobular carcinoma in situ (LCIS), involving a single area of variable size (up to a quadrant) in seven cases and the entire gland in three cases. Histologically, calcifications were associated with necrotic central areas within the in situ carcinomatous foci. Multiple foci of LCIS were observed in all five cases in which mastectomy had been performed. Cytologically, the lesions were characterized by a solid proliferation of round noncohesive cells with nuclei of intermediate size. Immunocytochemically, all cases were E-cadherin and p53 negative, and c-ErbB-2, GCDFP-15 and estrogen receptor positive. The proliferation index, evaluated with Ki67, was in the low range. Four cases were associated with foci of infiltrating lobular carcinoma (ILC). These findings contradict the commonly held opinion that LCIS is not mammographically detectable because of its lack of necrosis and calcification. This study documents the existence of a variant of LCIS exhibiting the mammographic features and central necrosis classically associated with ductal carcinoma in situ (DCIS), while retaining the spatial distribution, cytological composition and immunocytochemical features of lobular carcinoma.

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Section: Discussioncontrasting

confidence: 96%

Mammographically detected in situ lobular carcinomas of the breast

Sapino

Frigerio²,

Peterse³

et al. 2000

Virchows Archiv

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“…In 1969, Hutter et al (13) attempted to create a clinical and pathologic correlation with mammographic findings in lobular carcinoma in situ. The patients previously reported by Synder (12) were added to 34 new patients with the diagnosis of lobular carcinoma in situ (13). The authors showed that mammographically detected finely stippled clusters of calcifications were often associated with lobular carcinoma in situ.…”

Section: Discussionmentioning

confidence: 99%

Lobular Carcinoma In Situ Diagnosed By Core Needle Biopsy: When Should It Be Excised?

et al. 2003

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Core needle biopsy is the preferred technique for evaluating breast masses and abnormal mammographic findings. The frequency of detection of noninvasive lobular lesions by core needle biopsy is increasing. Historically, the diagnosis of lobular carcinoma in situ has been considered a risk factor for the development of invasive carcinoma, and treatment has consisted of careful clinical follow-up with or without chemopreventive therapeutic agents such as tamoxifen citrate. We retrospectively reviewed core needle biopsy material with the primary diagnoses of lobular carcinoma in situ, atypical lobular hyperplasia, and lobular neoplasia in conjunction with clinical and radiographic findings to make recommendations as to when excision may be merited. We searched our database for core needle biopsy cases with lobular carcinoma in situ, atypical lobular hyperplasia, and lobular neoplasia as the primary diagnosis. Microcalcifications had been sampled with a stereotactically guided, 11 G Mammotome biopsy device, and masses had been sampled with an ultrasound guided, 18 G core needle. Glass slides were reviewed and histological parameters assessed. Mammographic findings were reviewed, and clinical information was obtained from the medical record. When available, excisional biopsy material was reviewed. The 2337 breast core needle biopsies performed from January 1995 to December 2001 included 35 (1.5%) with classic lobular carcinoma in situ (14), lobular neoplasia (4), and atypical lobular hyperplasia (17) as the primary diagnosis. Twelve of these 35 cases (34%) had histological evidence of microcalcifications directly associated with the lobular carcinoma in situ, lobular neoplasia, atypical lobular hyperplasia. Radiologic review revealed 21 calcifications, 6 ultrasonographic masses, and 8 mammographic masses and/or architectural distortions. Excisional biopsy had been performed in 17 cases (49%). In six cases diagnosed as in situ on core needle biopsy, excisional biopsy revealed invasive carcinoma. All of these patients had radiographically detectable masses. Eleven cases had excisional biopsies that showed histology similar to that of the core needle biopsies. The most important predictor of invasive carcinoma on excision was a synchronous mass lesion. Lobular carcinoma in situ involving adenosis and lobular carcinoma in situ with pagetoid spread on core needle biopsies did not show a histologically more aggressive lesion on excision and, therefore, may not require additional surgery. Histologically identified calcifications were associated with lobular lesions 34% of the time; however, their presence inside an in situ lobular lesion did not portend worse pathology on re-excision and should not be a criterion for excision. Based on these findings, we recommend excisional biopsy of lobular carcinoma in situ, atypical lobular hyperplasia or lobular neoplasia only when it is associated with a synchronous mass lesion. The increased use of screening mammography has resulted in an increasing number of image-guided breast biop...

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“…They are best described as cancer-associated microcalcifications, since they are typically found in tissue near a focus of LCIS and rarely within it [2]. When benign or suspicious clusters of microcalcifications (with or without added densities) were biopsied, LCIS was often found adjacent to areas of sclerosing adenosis or apocrine metaplasia.…”

Section: Discussionmentioning

confidence: 99%