LCIS requires that all the acini in at least one lobular unit be completely filled and that half the acini in that unit must be expanded
If either of the above features is lacking, designate as ALH
Lobular carcinoma in situ is considered to be a marker of increased risk of invasive carcinoma it can be a precursor lesion
The increased risk applies to both breasts in most studies
Recent data suggest 2/3 of subsequent carcinomas are in the ipsilateral breast
In the past there has been no consensus about management of patients with LCIS in a core biopsy
A recent study provides data indicating that patients with LCIS in a core should have an excision
We particularly consider its presence in a core biopsy to be an indication for excisional biopsy in the following situations:
If there is discordance between the mammographic and pathologic findings
If another lesion such as atypical ductal hyperplasia is present
If the lobular nature of the cells is at all equivocal
If the LCIS is extensive
In an excisional biopsy:
We suggest excision with clear margins if florid/extensive, pleomorphic, extensively necrotic or predominantly signet ring
Otherwise, margins are not relevant if LCIS is the only lesion
Nevertheless, we generally report margin status to satisfy those who want the information
Relative risk for development of invasive breast carcinoma
No increased risk
Non-proliferative fibrocystic change
Slightly increased risk (1.5 to 2 times)
Proliferative fibrocystic change
Usual ductal hyperplasia
Sclerosing adenosis (florid)
Complex fibroadenoma (approximately 3 times risk)
Moderately increased risk (4 to 5 times)
Atypical ductal hyperplasia (no family history)
Atypical lobular hyperplasia
High risk (8 to 10 times)
Ductal carcinoma in situ, low grade
Lobular carcinoma in situ
Atypical ductal hyperplasia, if history of carcinoma in primary relatives
Very high risk (precise level not known)
Ductal carcinoma in situ, high grade
Grading / Staging / Report
Grading is not applicable
Staging is not applicable
The surgical pathology report should contain or address the following:
Type of resection or biopsy and location
Results of any supplementary studies performed
Extent of LCIS
(Margins of excision are not relevant)
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