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Evaluating the Rate of Upgrade to Invasive Breast Cancer and/or Ductal Carcinoma In Situ Following a Core Biopsy Diagnosis of Non-classic Lobular Carcinoma In Situ

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A diagnosis of non-classic lobular carcinoma in situ (NC-LCIS) encompasses a variety of lesions with poorly characterized natural history. We evaluated upgrade rates and factors associated with upgrade to malignancy following a core biopsy diagnosis of NC-LCIS, and its natural history.

Methods

Upon Institutional Review Board approval, pathology databases were searched for NC-LCIS core biopsy diagnoses (carcinoma in situ [CIS], CIS with ductal and lobular features [CIS/DLF], pleomorphic LCIS [P-LCIS], variant LCIS [V-LCIS], LCIS with necrosis). Cases with available core and excision pathology were included, while cases with concurrent ipsilateral invasive carcinoma (IC), ductal carcinoma in situ (DCIS), and/or atypical ductal hyperplasia were excluded.

Results

Overall, 121 NC-LCIS cases were identified from 1998 to 2017. We excluded 46 cases with concurrent cancer; 75 patients with 76 NC-LCIS core biopsy diagnoses followed by excision formed our study cohort. Median age was 56 years (range 41–83), and all imaging findings were classified as Breast Imaging Reporting and Data System 4; calcifications were the most common biopsy indication (80%). Excision yielded malignancy in 27 (36%) patients (IC 17, 63%; DCIS alone 10, 37%). We were unable to identify radiologic or pathologic features predictive of upgrade. Of 49 pure NC-LCIS cases, 15 (31%) had mastectomy, 9 (18%) had excision and radiation, and 25 (51%) had excision alone. At a median follow-up of 58 months (range 1–224), 1/25 (4%) patients with excision alone developed ipsilateral DCIS 14 months later.

Conclusions

In this series of NC-LCIS, 36% of cases were upgraded, supporting routine excision. We were unable to identify predictors of upgrade. Among 25 patients with pure NC-LCIS, only one patient developed a future ipsilateral cancer. Further study of the natural history of NC-LCIS is warranted.

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Faina Nakhlis MD & Tari A. King MD

  2. Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA

    Beth T. Harrison MD & Susan C. Lester MD, PhD

  3. Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Catherine S. Giess MD

  4. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    Kevin S. Hughes MD & Suzanne B. Coopey MD

  5. Dana-Farber/Harvard Cancer Center, Boston, MA, USA

    Faina Nakhlis MD, Beth T. Harrison MD, Catherine S. Giess MD, Susan C. Lester MD, PhD, Kevin S. Hughes MD, Suzanne B. Coopey MD & Tari A. King MD

  6. Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Faina Nakhlis MD & Tari A. King MD

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  1. Faina Nakhlis MD
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  2. Beth T. Harrison MD
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  3. Catherine S. Giess MD
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  4. Susan C. Lester MD, PhD
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  7. Tari A. King MD
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Correspondence to Tari A. King MD.

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Nakhlis, F., Harrison, B.T., Giess, C.S. et al. Evaluating the Rate of Upgrade to Invasive Breast Cancer and/or Ductal Carcinoma In Situ Following a Core Biopsy Diagnosis of Non-classic Lobular Carcinoma In Situ. Ann Surg Oncol 26, 55–61 (2019). https://doi.org/10.1245/s10434-018-6937-0

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  • DOI: https://doi.org/10.1245/s10434-018-6937-0

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