Lobular carcinoma in situ (LCIS) of the breast: is long-term outcome similar to ductal carcinoma in situ (DCIS)? Analysis of 200 cases

Abstract

BackgroundLobular carcinomas in situ (LCIS) represent 1-2% of all breast cancers. Both significance and treatment remain widely debated, as well as the possible similarities with DCIS.Materials and methodsTwo hundred patients with pure LCIS were retrospectively analyzed in seven centres from 1990 to 2008. Median age was 52 years; 176 patients underwent breast-conserving surgery (BCS) and 24 mastectomy. Seventeen patients received whole breast irradiation (WBRT) after BCS and 20 hormonal treatment (15 by tamoxifen).ResultsWith a 144-month median follow-up (FU), there were no local recurrences (LR) among 24 patients treated by mastectomy. With the same FU, 3 late LR out of 17 (17%) occurred in patients treated by BCS and WBRT (with no LR at 10 years). Among 159 patients treated by BCS alone, 20 developed LR (13%), but with only a 72-month FU (17.5% at 10 years). No specific LR risk factors were identified. Three patients developed metastases, two after invasive LR; 22 patients (11%) developed contralateral BC (59% invasive) and another five had second cancer.ConclusionsLCIS is not always an indolent disease. The long-term outcome is quite similar to most ductal carcinomas in situ (DCIS). The main problems are the accuracy of pathological definition and a clear identification of more aggressive subtypes, in order to avoid further invasive LR. BCS + WBRT should be discussed in some selected cases, and the long-term results seem comparable to DCIS.

Descriptive study comparing outcomes of classic and nonclassic lobular carcinoma in situ (florid and pleomorphic) initially diagnosed on core needle biopsy

“…9 Especially while considering management, both PLCIS and FLCIS are considered aggressive LCIS subtypes. 5 In conclusion, we report distinct recurrence patterns of NCLCIS.…”

Associations of race and ethnicity with risk of developing invasive breast cancer after lobular carcinoma in situ

“…As a strategy of risk reduction, LCIS patients with higher risk, such as women with BRCA 1 or BRCA 2 genetic mutations, may undergo bilateral prophylactic mastectomy [10]. There is limited support for the addition of radiation therapy, but a small cohort study suggested some benefits [13]. Based on the more recent findings of Taylor et al [29], there was no significant difference in overall survival between patients who received lumpectomy alone or lumpectomy with radiation treatment.…”

“…This abnormal proliferation of cells frequently originates in the terminal ductal lobular unit of the breast and may spread to the ducts [12]. LCIS may also be associated with the development of invasive ductal carcinoma, typically estrogen receptor-positive (ER+) lesions [13].…”

Lobular Carcinoma in Situ with Atypical Mass Presentation: a Case Report

“…Furthermore, the risk of invasive disease increases when there is an association with other lesions, such as ductal hyperplasia, or first-degree family history of invasive cancer. 6 Patients are offered one of three treatment options: lifetime monitoring to detect subsequent malignancy at an early stage; chemoprevention, with tamoxifen being the most used drug, as it reduces the risk of developing cancer in the subsequent four years by 56%; or prophylactic bilateral mastectomy. 26 Additionally, for patients with a positive classical LCIS margin, as in the present case, there is no consensus regarding reoperation, though 7% to 53% of surgeons choose to reoperate.…”

“…Diagnosis is usually more common among 40-to 50-year-old women, 5 15 years prior to the mean age at which an invasive carcinoma occurs 2,3 and 7 to 8 years earlier than the occurrence of ductal carcinoma in situ (DCIS). 6 Keywords ► breast ► cancer ► breast ultrasound ► mammography…”