Lobular Carcinoma In Situ: A Rare Form of Mammary Cancer

Foote, Frank W.; Stewart, Fred W.

doi:10.3322/canjclin.32.4.234

Cited by 196 publications

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“…1,18 They occur predominantly in premenopausal women, with most cases being diagnosed in women between 40 and 50 years of age. 13,[19][20][21][22] They are clinically occult, and although they are often also mammographically silent, a significant minority of lobular neoplasia cases diagnosed on core biopsy have associated microcalcifications.…”

Section: Clinical Featuresmentioning

confidence: 99%

Lobular neoplasia: morphology, biological potential and management in core biopsies

O’Malley

2010

Modern Pathology

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Lobular neoplasia has been traditionally recognized as a marker of increased risk for subsequent breast carcinoma development; however, molecular studies suggest that it also behaves in a non-obligate precursor manner. We do not know, as yet, how to identify the subgroup of cases that is most likely to progress, but the epidemiological data would indicate that this progression occurs after a long period of time. Thus, the current approach of conservative management of these lesions when identified in excision specimens is justified. Recently, several variants of lobular carcinoma in situ (LCIS), most notably pleomorphic LCIS, have been recognized and these can be difficult to differentiate from ductal carcinoma in situ. Application of strict diagnostic criteria and the judicial use of immunohistochemistry, particularly E-cadherin, can be helpful in this differential diagnosis. Another challenging issue is the management of lobular neoplasia when diagnosed on core biopsy. This controversial issue will be discussed in detail. The goals of this review are (1) to describe the morphological criteria used to diagnose the spectrum of lobular neoplastic lesions, including atypical lobular hyperplasia, LCIS and variants of LCIS; (2) to discuss the data exploring the biological potential of lobular neoplasia from an epidemiological and molecular viewpoint; and (3) to outline the recommendations for management of lobular neoplasia when encountered in core biopsies.

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Section: Clinical Featuresmentioning

confidence: 99%

Lobular neoplasia: morphology, biological potential and management in core biopsies

O’Malley

2010

Modern Pathology

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“…1,2 Lobular neoplasia are considered risk factors for subsequent invasive carcinoma in either breast with relative risk of 4 to 5 times for atypical lobular hyperplasia and up to 8 to 10 times for lobular carcinoma in situ. [3][4][5] The majority of breast cancers that subsequently developed were invasive ductal carcinoma.…”

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confidence: 99%

Classic lobular neoplasia on core biopsy: a clinical and radio-pathologic correlation study with follow-up excision biopsy

Chaudhary

Lawrence

McGinty³

et al. 2013

Modern Pathology

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There are no consensus guidelines for the management of lobular neoplasia diagnosed on core biopsy as the highest risk factor for cancer. This study aimed to assess the risk of upgrade (invasive carcinoma or ductal carcinoma in situ) at the site of the lobular neoplasia and any clinical, radiological or pathologic factors associated with the upgrade. We reviewed all cases with a diagnosis of lobular neoplasia on core biopsy from June 2006 to June 2011. Any cases with radio-pathologic discordance, coexistent lesion that required excision (atypical ductal hyperplasia, flat epithelial atypia, duct papilloma or radial scar) or non-classic variant of lobular carcinoma in situ (pleomorphic, mixed ductal and lobular, lobular carcinoma in situ with necrosis) were excluded from the study. Core biopsy indications included calcification in 35 (40%), non-mass like enhancement in 19 (22%), mass lesion in 31 (36%) and mass as well as calcification in two cases (2%). Follow-up excisions were studied for the presence of upgrade. The study cohort included 87 cases and showed an upgrade of 3.4% (95% confidence interval: 1-10%). Three cases showed an upgrade (one ductal carcinoma in situ and two invasive cancers). All upgraded cases were breast imaging-reporting and data system score Z4 and associated with atypical duct hyperplasia or in situ or invasive cancer in prior or concurrent biopsies in either breast. The number of cores and lobules involved, pagetoid duct involvement, presence of microcalcification in lobular neoplasia, needle gauge and number of cores obtained showed no correlation with the upgrade. Our results suggest that with radio-pathologic concordance and no prior biopsy proven risk for breast cancer, core biopsy finding of lobular neoplasia as the highest risk lesion can be appropriately and safely managed with clinical and radiologic follow-up as an alternative to surgical excision. Modern Pathology (2013) 26, 762-771; doi:10.1038/modpathol.2012 published online 11 January 2013 Keywords: atypical lobular hyperplasia; core biopsy; excision; follow-up; lobular carcinoma in situ; lobular neoplasia; upgrade Lobular neoplasia that includes atypical lobular hyperplasia and lobular carcinoma in situ was first described by Foote and Stewart in 1941 and later by Haagensen in 1978. 1,2 Lobular neoplasia are considered risk factors for subsequent invasive carcinoma in either breast with relative risk of 4 to 5 times for atypical lobular hyperplasia and up to 8 to 10 times for lobular carcinoma in situ. [3][4][5] The majority of breast cancers that subsequently developed were invasive ductal carcinoma. [3][4][5] Classic type lobular carcinoma in situ is defined as a monotonous, discohesive proliferation of small, round cells with low to intermediate nuclear grade, evenly spaced, that both fill and distend 450% of the acini of the involved lobular units. 6,7 Atypical lobular hyperplasia is defined as the same cell population but witho50% of the acini filled and distended. 6,7 Since classic atypical lobular hyperplasia and...

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“…Although mentioned in the literature since the early 1900s, to our knowledge the histologic features of lobular carcinoma in situ (LCIS) were first explicitly described by Foote and Stewart in 1941. 1 The term was established to articulate the mor-phologic parallels between the cells of LCIS and invasive lobular carcinoma. The designation of atypical lobular hyperplasia (ALH) consequently evolved to describe those lesions that are similar to LCIS, but which fall quantitatively short of the diagnostic criteria.…”

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Lobular neoplasia on core needle biopsy does not require excision

Nagi

O'Donnell

Tismenetsky

et al. 2008

Cancer

106

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BACKGROUND. Lobular neoplasia (LN), encompassing atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), is often an incidental finding on core needle biopsies (CNBs) performed in instances of radiologic densities and/or calcifications. Because LN is generally considered a risk factor for breast carcinoma, the utility of subsequent excision is controversial. METHODS. The authors' database yielded 98 cases of LCIS and/or ALH. Cases containing LN accompanied by a second lesion mandating excision (eg, radial scar, atypical ductal hyperplasia [ADH]) and those failing to meet strict diagnostic criteria for LN (eg, atypical cells, mitoses, single‐cell necrosis) were excluded. Radiographic calcifications were correlated with their histologic counterparts in terms of size, number, and pattern. RESULTS. Ninety‐one biopsies were performed for calcifications and 7 were performed for mass lesions. The ages of the patients ranged from 35 to 82 years. Fifty‐three patients were followed radiologically without excision, 42 of whom had available clinicoradiologic information. The 45 patients who underwent excision were without disease at follow‐up periods ranging from 1 to 8 years. Of these 45 patients, 42 (93%) had biopsy results demonstrating only LN. The remaining 3 patients had biopsies with the following findings: ADH in 1 biopsy, residual LCIS and a separate minute focus of infiltrating lobular carcinoma (clearly an incidental finding) in the second biopsy, and ductal carcinoma in situ admixed with LCIS in the third biopsy (a retrospective examination performed by 2 blinded breast pathologists revealed foci of atypical cells and mitoses). CONCLUSIONS. Excision of LN is unnecessary provided that: 1) careful radiographic‐pathologic correlation is performed; and 2) strict histologic criteria are adhered to when making the diagnosis. Close radiologic and clinical follow‐up is adequate. Cancer 2008. © 2008 American Cancer Society.

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Lobular Carcinoma In Situ: A Rare Form of Mammary Cancer

Cited by 196 publications

References 0 publications

Lobular neoplasia: morphology, biological potential and management in core biopsies

Lobular neoplasia: morphology, biological potential and management in core biopsies

Classic lobular neoplasia on core biopsy: a clinical and radio-pathologic correlation study with follow-up excision biopsy

Lobular neoplasia on core needle biopsy does not require excision

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