Annals of Surgical Oncology

, Volume 26, Issue 1, pp 55–61 | Cite as

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

  • Faina Nakhlis
  • Beth T. Harrison
  • Catherine S. Giess
  • Susan C. Lester
  • Kevin S. Hughes
  • Suzanne B. Coopey
  • Tari A. KingEmail author
Breast Oncology



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.


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.


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.


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.





  1. 1.
    Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, Van de Vijver M. WHO Classification of Tumours of the Breast, 4th ed. Lyon: IARC Press; 2012.Google Scholar
  2. 2.
    Fadare O, Dadmanesh F, Alvarado-Cabrero I, et al. Lobular intraepithelial neoplasia [lobular carcinoma in situ] with comedo-type necrosis: a clinicopathologic study of 18 cases. Am J Surg Pathol 2006;30:1445–53.CrossRefGoogle Scholar
  3. 3.
    Alvarado-Cabrero I, Picon Coronel G, Valencia Cedillo R, Canedo N, Tavassoli FA. Florid lobular intraepithelial neoplasia with signet ring cells, central necrosis and calcifications: a clinicopathological and immunohistochemical analysis of ten cases associated with invasive lobular carcinoma. Arch Med Res 2010;41:436–41.CrossRefGoogle Scholar
  4. 4.
    Tavassoli FA. Lobular neoplasia: evolution of its significance and morphologic spectrum. Int J Surg Pathol 2010;18(3 Suppl):174S–7S.CrossRefGoogle Scholar
  5. 5.
    Shin SJ, Lal A, De Vries S, et al. Florid lobular carcinoma in situ: molecular profiling and comparison to classic lobular carcinoma in situ and pleomorphic lobular carcinoma in situ. Hum Pathol 2013;44:1998–2009.CrossRefGoogle Scholar
  6. 6.
    Frost AR, Tsangaris TN, Silverberg SG. Pleomorphic lobular carcinoma in situ. Pathol Case Rev 1996;1:27–30.CrossRefGoogle Scholar
  7. 7.
    Sneige N, Wang J, Baker BA, Krishnamurthy S, Middleton LP. Clinical, histopathologic, and biologic features of pleomorphic lobular (ductal-lobular) carcinoma in situ of the breast: a report of 24 cases. Mod Pathol 2002;15:1044–50.CrossRefGoogle Scholar
  8. 8.
    Gomes DS, Porto SS, Balabram D, Gobbi H. Inter-observer variability between general pathologists and a specialist in breast pathology in the diagnosis of lobular neoplasia, columnar cell lesions, atypical ductal hyperplasia and ductal carcinoma in situ of the breast. Diagn Pathol 2014;9:121.CrossRefGoogle Scholar
  9. 9.
    Sullivan ME, Khan SA, Sullu Y, Schiller C, Susnik B. Lobular carcinoma in situ variants in breast cores: potential for misdiagnosis, upgrade rates at surgical excision, and practical implications. Arch Pathol Lab Med 2010;134:1024–8.Google Scholar
  10. 10.
    Georgian-Smith D, Lawton TJ. Calcifications of lobular carcinoma in situ of the breast: radiologic-pathologic correlation. AJR Am J Roentgenol 2001;176:1255–9.CrossRefGoogle Scholar
  11. 11.
    Lavoue V, Graesslin O, Classe JM, Fondrinier E, Angibeau H, Leveque J. Management of lobular neoplasia diagnosed by core needle biopsy: study of 52 biopsies with follow-up surgical excision. Breast 2007;16:533–9.CrossRefGoogle Scholar
  12. 12.
    Chivukula M, Haynik DM, Brufsky A, Carter G, Dabbs DJ. Pleomorphic lobular carcinoma in situ (PLCIS) on breast core needle biopsies: clinical significance and immunoprofile. Am J Surg Pathol 2008;32:1721–6.CrossRefGoogle Scholar
  13. 13.
    Carder PJ, Shaaban A, Alizadeh Y, Kumarasuwamy V, Liston JC, Sharma N. Screen-detected pleomorphic lobular carcinoma in situ (PLCIS): risk of concurrent invasive malignancy following a core biopsy diagnosis. Histopathology 2010;57:472–8.CrossRefGoogle Scholar
  14. 14.
    Niell B, Specht M, Gerade B, Rafferty E. Is excisional biopsy required after a breast core biopsy yields lobular neoplasia? AJR Am J Roentgenol 2012;199:929–35.CrossRefGoogle Scholar
  15. 15.
    Meroni S, Bozzini AC, Pruneri G, et al. Underestimation rate of lobular intraepithelial neoplasia in vacuum-assisted breast biopsy. Eur Radiol 2014;24:1651–8.CrossRefGoogle Scholar
  16. 16.
    Flanagan MR, Rendi MH, Calhoun KE, Anderson BO, Javid SH. Pleomorphic lobular carcinoma in situ: radiologic-pathologic features and clinical management. Ann Surg Oncol 2015;22:4263–9.CrossRefGoogle Scholar
  17. 17.
    Susnik B, Day D, Abeln E, et al. Surgical outcomes of lobular neoplasia diagnosed in core biopsy: prospective study of 316 cases. Clin Breast Cancer 2016;16:507–13.CrossRefGoogle Scholar
  18. 18.
    Guo T, Wang Y, Shapiro N, Fineberg S. Pleomorphic lobular carcinoma in situ diagnosed by breast core biopsy: clinicopathologic features and correlation with subsequent excision. Clin Breast Cancer. 2018;18:e449–e454.CrossRefGoogle Scholar
  19. 19.
    Downs-Kelly E, Bell D, Perkins GH, Sneige N, Middleton LP. Clinical implications of margin involvement by pleomorphic lobular carcinoma in situ. Arch Pathol Lab Med 2011;135:737–43.Google Scholar
  20. 20.
    De Brot M, Koslow Mautner S, Muhsen S, et al. Pleomorphic lobular carcinoma in situ of the breast: a single institution experience with clinical follow-up and centralized pathology review. Breast Cancer Res Treat 2017;165:411–20.CrossRefGoogle Scholar
  21. 21.
    Khoury T, Karabakhtsian RG, Mattson D, et al. Pleomorphic lobular carcinoma in situ of the breast: clinicopathological review of 47 cases. Histopathology 2014;64:981–93.CrossRefGoogle Scholar
  22. 22.
    King TA, Reis-Filho JS. Lobular neoplasia. Surg Oncol Clin N Am 2014;23:487–503.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Faina Nakhlis
    • 1
    • 5
    • 6
  • Beth T. Harrison
    • 2
    • 5
  • Catherine S. Giess
    • 3
    • 5
  • Susan C. Lester
    • 2
    • 5
  • Kevin S. Hughes
    • 4
    • 5
  • Suzanne B. Coopey
    • 4
    • 5
  • Tari A. King
    • 1
    • 5
    • 6
    Email author
  1. 1.Department of SurgeryBrigham and Women’s HospitalBostonUSA
  2. 2.Department of PathologyBrigham and Women’s HospitalBostonUSA
  3. 3.Department of RadiologyBrigham and Women’s HospitalBostonUSA
  4. 4.Department of SurgeryMassachusetts General HospitalBostonUSA
  5. 5.Dana-Farber/Harvard Cancer CenterBostonUSA
  6. 6.Dana-Farber/Brigham and Women’s Cancer CenterBostonUSA

Personalised recommendations