Significance of lobular intraepithelial neoplasia at margins of breast conservation specimens: a report of 38 cases and literature review

Abstract

BackgroundPresence of lobular intraepithelial neoplasia (LIN) is not routinely reported as part of margin assessment in breast conservation therapy (BCT) as in ductal carcinoma in situ (DCIS). With new emerging evidence of LIN as possible precursor lesion, the hypothesis is that LIN at the margin may increase the risk of local recurrence with BCT. The aim is to determine whether there is an increase incidence of recurrence when LIN is found at surgical margins on BCT.MethodsWe retrospectively reviewed a total of 1,334 BCT at a single institution in a 10 year period. Inclusion criteria are positive margin with LIN from primary BCT containing invasive and/or in situ carcinoma with comparison to the negative control group who had similar diseases with negative margin for LIN.ResultsWe identified 38 cases (2.8%) with LIN either lobular carcinoma in situ/atypical lobular hyperplasia (LCIS/ALH) at a margin on initial BCT with 36% recurrence rate. Of the 38 cases: 5 (13%) were lost to follow-up, 12 (32%) had no further procedures performed and 21 (55%) had re-excision. Out of 21 patients who had re-excisions, 12 (57%) had residual invasive carcinoma or DCIS, three (14%) had pleomorphic LCIS and 4 (19%) showed residual classic type LCIS. 71% had significant residual disease (local recurrence) and 29% had no residual disease. A negative control group consisted of 38 cases. We found two patients with bone or brain metastasis and one local recurrence. Clinical follow up periods range from 1 to 109 months.ConclusionsLIN found at a margin on BCT showed a significant recurrent ipsilateral disease. Our study supports the view that LIN seen at the margin may play a role in recurrence.

WITHDRAWN: Innovative Surgical System for Breast Cancer Based on Real-time Excising of Hypoxic Lesions Significantly Reduced the Positive Cavity Side Margin

“…Also, it is the rst time that such an electrical diagnoser would be applied as an intra-operative margin detection approach in clinics. Here, after recording and calibrating hypoxia based margin diagnosis on 258 fresh breast samples had been resected from 74 patients, quanti ed diagnostic scorings of CDP response peaks were de ned in correlation with their permanent histopathology results based on world health organization (WHO) classi cation of breast tumors [10], [11], [12], [13] that proposed for CDP scores. This diagnostic approach was veri ed by clinical trials on 188 patients undergone BCS/mastectomy surgeries.…”

Features of Pure Lobular Carcinoma In Situ on Magnetic Resonance Imaging Associated with Immediate Re-Excision after Lumpectomy

“…This guideline was based on a few studies in which the presence of LCIS at the resection margin did not affect subsequent local recurrence [ 8 9 ]. However, another study reported that LCIS or atypical lobular hyperplasia at the margin was significantly associated with increased local recurrence [ 10 ]. The latter study reported a recurrence rate of 39% in the positive margin group compared with a recurrence rate of just 7.9% in the negative control group.…”

Electrochemical tracing of hypoxia glycolysis by carbon nanotube sensors, a new hallmark for intraoperative detection of suspicious margins to breast neoplasia

“…Samples consisted of ADH with more than two foci, DCIS and IDCs most often showed peak currents higher than 203µA, while others consisted of one focus of ADH, UDH, and FCC lesions showed peak currents lower than 196µA. Hence, the responses of CDP are classifiable based on the newest edition of ductal intraepithelial neoplasia (DIN) [10], lobular intraepithelial neoplasia (LIN) [11], and fibroepithelial lesion (FEL) [12] systems reported by the world health organization (WHO) [13]. Most abnormal samples were found in DIN classification (as the most occurred types of breast diseases such as IDC, DCIS, ADH, and UDH).…”

“…It is the first time that such an electrical diagnoser would be applied as a real-time cancer detector in live tissues. Here, after recording and calibrating hypoxia based margin diagnosis on 258 fresh breast tumor samples, quantified diagnostic scorings of CDP response peaks were defined in correlation with their permanent histopathology results based on the world health organization (WHO) classification of breast tumors [10], [11], [12], [13]. This diagnostic approach showed more than 95% sensitivity in its best calibration, which shed new light for application as a surgeon assistant in the future after passing clinical trials.…”