Lobular carcinoma in situ: Observation without surgery as an appropriate therapy
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Background: The finding of lobular carcinoma in situ (LCIS) in the breast has generally prompted treatment with unilateral or bilateral mastectomy. Most experts now feel that LCIS simply identifies a woman who is at high risk to develop future breast cancer and requires only close clinical and mammographic follow-up. This approach has been recommended at our institution for >15 years. This study defines the natural history of a population of women with LCIS who were treated by observation alone.
Methods: Women with a pathologic diagnosis of LCIS were identified by tumor registry search. Records and pathology were reviewed. Radiographic-pathologic correlation was performed on women who had undergone mammographic-localized breast biopsies. One hundred forty-nine women with LCIS were identified. Eighty four were excluded from analysis because of synchronous invasive cancer or ductal carcinoma in situ (DCIS). The remaining 65 women formed the basis of this report.
Results: Sixty-five women with LCIS were treated from 1963 through 1990. Median follow-up was 83 months. No women were lost to follow-up. Median age at diagnosis was 48 years (range 37–81), and 32% had a family history of breast cancer. Clinical findings leading to biopsy were breast mass in 43, nipple discharge in three, and mammographic abnormality in 19. Mammographic-pathologic correlation showed that the focus of LCIS in these 19 women was not associated with the mammographic abnormality. Fourteen of 65 women underwent mastectomy after diagnosis of LCIS (nine ipsilateral, five bilateral). Fifty-one of 65 women elected observation alone. In the observation group, 13 of 51 women (25%) underwent a second breast biopsy for a clinical or mammographic abnormality during the follow-up period. The median interval to biopsy was 50 months. Pathology was benign in two, LCIS in seven, DCIS in one, and invasive cancer in three. All seven women with LCIS on subsequent biopsy continued with observation and none developed breast cancer. All four cancers were detected by mammography without an associated palpable mass. Three of four cancer masses were <1 cm in diameter. The woman with DCIS was 47 years of age and developed DCIS 106 months after LCIS diagnosis. She was treated by total mastectomy and is disease free 108 months later. The three women with invasive cancer developed this at 41, 53, and 69 months after diagnosis of LCIS. All were <50 years of age. All three cancers were in the same breast as the previous LCIS. Two women were treated by modified radical mastectomy, and the third had wide excision/axillary dissection followed by radiation therapy. They are alive and disease-free at 16, 82, and 116 months.
Conclusions: Four of 51 women treated with observation alone after diagnosis of LCIS developed breast cancer. All were detected by screening at an early stage. LCIS appeared to be an incidental finding on biopsy of mammographic abnormalities. The policy of observation alone for the finding of LCIS spares women mastectomy. Furthermore, cancers that develop in follow-up are likely to be detected at an early stage and be amenable to curative therapy. Observation alone is appropriate treatment for women with LCIS.
- Foote FW, Stewart FW. Lobular carcinoma in situ: a rare form of mammary cancer.Am J Pathol 1941;17:491–5.
- Haagensen CD, Lane N, Lattes R, Bodian C. Lobular neoplasia (so-called lobular carcinoma in situ) of the breast.Cancer 1978;42:737–69.
- Haagensen CD.Disease of the breast. 3rd ed. Philadelphia: WB Saunders, 1986.
- Sonnenfeld MR, Frenna TH, Weidner N, Meyer JE. Lobular carcinoma in situ: mammographic-pathologic correlation of results of needle-directed biopsy.Radiology 1991;181:363–7.
- Salvadori B, Bartoli C, Surrida S, Luccilla B. Risk of invasive cancer in woman with lobular carcinoma in situ of the breast.Eur J Cancer 1991;27:35–7.
- Hutter RVP, Snyder RE, Lucas JC, et al. Clinical and pathologic correlation with mammographic findings in lobular carcinoma in situ.Cancer 1969;23:826–39.
- Snyder RE. Mammography and lobular carcinoma in situ.Surg Gynecol Obstet 1966;122:255–60.
- Harris JR.Breast disease. Philadelphia: JB Lippincott, 1987.
- Powers RW, O'Brien PH, Kreutner A. Lobular carcinoma in situ.J Surg Oncol 1980;12:269–73.
- Sunshine JA, Mosely HS, Fletcher WS, et al. Breast carcinoma in situ: a retrospective review of 112 cases with a minimum 10 year follow up.Am J Surg 1985;150:44–9. CrossRef
- Anderson JA. Lobular carcinoma in situ: a long-term follow up in 52 cases.Acta Pathol Microbiol Scand 1974;82:519–33.
- Wheeler JE, Enterline HT, Roseman JM, et al. Lobular carcinoma in situ of the breast.Cancer 1974;34:554–63.
- McDivitt RW, Hutter RVP, Foote FW, Stewart FW. In situ lobular carcinoma: a prospective follow up study indicating cumulative patient risks.JAMA 1967;201:96–100. CrossRef
- Rosen PP, Braum DW, Lyngholm B, Urban JA, Kinne DW. Lobular carcinoma in situ of the breast: preliminary results of treatment by ipsilateral mastectomy and contralateral biopsy.Cancer 1981;47:813–9.
- Hutter RVP. The management of patients with lobular carcinoma in situ of the breast.Cancer 1984;53:798–802.
- Frykberg ER, Santiago R, Betsill WL, O'Brien PH. Lobular carcinoma in situ of the breast.Surg Gynecol Obstet 1987;164:285–301.
- Rosen PP, Kosloff C, Lieberman PH, et al. Lobular carcinoma of the breast. Detailed analysis of 99 patients with average follow up of 24 years.Am J Surg Pathol 1978;2:225–51.
- Nayfield SG, Karp JE, Ford LG, Dorr FA, Kramer BS. Potential role of Tamoxifen prevention of breast cancer.J Natl Cancer Inst 1991;83:1450–9.
- Lobular carcinoma in situ: Observation without surgery as an appropriate therapy
Annals of Surgical Oncology
Volume 1, Issue 2 , pp 141-146
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- Lobular carcinoma in situ
- Breast cancer
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- Author Affiliations
- 1. From the Department of Surgical Oncology, Roswell Park Cancer Institute, State University of New York, Buffalo, New York, USA
- 2. the Department of Radiology, Roswell Park Cancer Institute, State University of New York, Buffalo, New York, USA
- 3. the Department of Pathology, Roswell Park Cancer Institute, State University of New York, Buffalo, New York, USA