Pleomorphic lobular carcinoma in situ of the breast: Can the evidence guide practice?

Abstract

The clinical significance of pleomorphic lobular carcinoma in situ (PLCIS) is a subject of controversy. As a consequence, there is a risk of providing inconsistent management to patients presenting with PLCIS. This review aims to establish whether the current guidelines for the management of PLCIS are consistent with current evidence. A systematic electronic search was performed to identify all English language articles regarding PLCIS management. The data was analysed, specifically looking at: incidence of concurrent disease, recurrence rates, long-term prognosis and PLCIS management. A search was also performed for PLCIS management guidelines for the United Kingdom, United States, Canada, Australia, Germany and pan-European. The results of the evidence analyses were compared to the guidelines in order to establish whether the recommended management is consistent with the published evidence. Nine studies (level 3-4 evidence), involving a total of 176 patients and five management guidelines (from United Kingdom, United States, Australia and pan-European) were included in the review. From the evidence, 46 of 93 (49%) patients were found to have PLCIS with concurrent invasive disease on excision specimen analysis. Regarding recurrence rates, 11 of 117 (9.4%) patients developed a recurrence of PLCIS. There were no instances of invasive disease or ductal carcinoma in situ (DCIS) on recurrence histology. There were no studies assessing long-term outcomes in PLCIS cases. With regards to the management guidelines, the Association of Breast Surgery (United Kingdom) and the National Breast and Ovarian Cancer Care (Australia) do not mention PLCIS. The National Comprehensive Cancer Network (United States) suggest considering excision of PLCIS with negative margins. The NHS Breast Screening Programme (United Kingdom) and the European Society of Medical Oncology (pan-European) recommend PLCIS should be treated as with DCIS. We conclude that high quality evidence to inform guidance is lacking, thus recommendations are relatively vague. However, based on the available evidence, it would seem prudent to treat PLCIS in a similar manner to DCIS. is a breast lesion, the clinical significance of which is a subject of controversy. To date, this systematic review is the largest pooled series of clinical data regarding PLCIS. We aimed to establish whether current guidelines for management are consistent with the evidence. The results demonstrate a lack of high quality data and guidelines for management are variable. Analysis revealed a high incidence of concurrent invasive disease with PLCIS (49%) and following excision, a recurrence rate of 9.4%. We conclude that it would seem prudent

Pleomorphic Lobular Carcinoma In Situ: Radiologic–Pathologic Features and Clinical Management

“…11 Due to these pathologic similarities, it has been suggested that management of PLCIS should mirror that of DCIS rather than CLCIS, including excision to clear surgical margins with or without adjuvant postlumpectomy radiation and endocrine therapy. 12–15 The risk of concurrent invasive disease, or upgrading, at excision has ranged in prior studies from 0 to 65 %. 9,12 Following excision, ipsilateral recurrence of PLCIS or of invasive breast cancer has been estimated at 3.8–19.4 %, suggesting that PLCIS may represent a precursor lesion to invasive cancer rather than a marker for increased breast cancer risk.…”

“…12–15 The risk of concurrent invasive disease, or upgrading, at excision has ranged in prior studies from 0 to 65 %. 9,12 Following excision, ipsilateral recurrence of PLCIS or of invasive breast cancer has been estimated at 3.8–19.4 %, suggesting that PLCIS may represent a precursor lesion to invasive cancer rather than a marker for increased breast cancer risk. 12,16 …”

Pleomorphic lobular carcinoma in situ: Current evidence and a systemic review

“…However, it has long been noted that unlike CLCIS, PLCIS may be frequently associated with invasive disease and has more aggressive course (4,9). PLCIS is considered to be a precursor of invasive disease rather than a marker of increased risk like CLCIS.…”

“…Further articles were identified by manual search through the references in previous reviews and studies (3,4). …”

Development of Multiple Primary Cancers in Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations of Kentucky

“…Pleomorphic LCIS is linked to a higher risk of invasive cancer and is often treated as though it is a cancer precursor. 50 The strongest evidence that LCIS is more of a risk indicator than a direct cancer precursor comes from registry-based studies. One study of women diagnosed with LCIS from 1973 to 1998 and treated with BCS found that 7% of women developed invasive breast cancer within 10 years, with the increased risk of invasive disease equally distributed between both breasts.…”