Imaging Spectrum of Lobular Carcinoma In Situ and Correlation with Pathology Findings

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1734411 ◽

2021 ◽

Author(s):

Pradipta C Hande ◽

Sarabjeet Kaur Arneja ◽

Sabita S. Desai

Keyword(s):

High Resolution ◽

Carcinoma In Situ ◽

Breast Imaging ◽

Histopathological Examination ◽

Incidental Finding ◽

Lobular Carcinoma ◽

Excision Biopsy ◽

Lobular Carcinoma In Situ ◽

Tissue Samples

Abstract Background Lobular carcinoma in situ (LCIS) is a noninvasive neoplasm that is known to have an increased relative risk for developing subsequent invasive breast carcinoma. Pure LCIS is usually an incidental finding on histopathological examination (HPE) of tissue samples. However, in the recent years, there has been an increasing trend seen in the diagnosis of LCIS. Purpose This article aims to bring out the spectrum of appearances on breast imaging in confirmed cases of pure LCIS on HPE and immunohistochemical. Materials and Methods Cases that were confirmed as pure LCIS on HPE from core or excision biopsy were retrospectively analyzed for abnormalities on breast imaging. Digital breast tomosynthesis mammography was performed with high-resolution ultrasound with elastography for all cases. Magnetic resonance imaging (MRI) was performed in cases wherever indicated, with dynamic postcontrast imaging after injecting intravenous gadolinium. Conclusion LCIS is recognized as an intermediate risk factor for the development of breast cancer. Pure LCIS has varied histology and imaging patterns on mammography, high-resolution ultrasound, and MRI. It is important to recognize the imaging appearances of these lesions to enable the radiologist to detect LCIS early for proper management.

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Ductal and lobular carcinoma in situ arising within an enlarging biopsy proven fibroadenoma

BMJ Case Reports ◽

10.1136/bcr-2020-237017 ◽

2021 ◽

Vol 14 (1) ◽

pp. e237017

Author(s):

Yara Z Feliciano ◽

Rochelle Freire ◽

Jose Net ◽

Monica Yepes

Keyword(s):

Needle Biopsy ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Incidental Finding ◽

Case Reports ◽

Lobular Carcinoma ◽

Lobular Carcinoma In Situ ◽

Current Case ◽

Malignant Changes

The diagnosis via core needle biopsy of concurrent ductal carcinoma in situ and lobular carcinoma in situ within an enlarging previously biopsied benign fibroadenoma in women in their 40s is rare. Several case reports have described the occurrence of malignant changes within fibroadenomas, usually as an incidental finding following excision, and few reports have documented the transition of a fibroadenoma to malignancy. The current case report emphasises the importance of re-biopsying enlarging fibroadenomas, even with otherwise maintained benign appearing features on imaging, in women in their 40s, in order to exclude the possibility of malignancy.

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Pathologic Upgrade Rates on Subsequent Excision When Lobular Carcinoma In Situ Is the Primary Diagnosis in the Needle Core Biopsy With Special Attention to the Radiographic Target

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0297-oa ◽

2013 ◽

Vol 137 (7) ◽

pp. 927-935 ◽

Cited By ~ 29

Author(s):

Timothy M. D'Alfonso ◽

Karin Wang ◽

Ya-Lin Chiu ◽

Sandra J. Shin

Keyword(s):

Core Biopsy ◽

Carcinoma In Situ ◽

Incidental Finding ◽

Lobular Carcinoma ◽

Primary Diagnosis ◽

Needle Core Biopsy ◽

Lobular Carcinoma In Situ ◽

Pathologic Diagnosis ◽

Microscopic Features

Context.—Lobular carcinoma in situ (LCIS) as the primary pathologic diagnosis in a needle core biopsy is an infrequent finding, and the management of patients in this setting is controversial. Objective.—To determine the rate of pathologic upgrade (defined as the presence of a clinically more-significant lesion in the subsequent excision) in patients with a primary pathologic diagnosis of LCIS in the needle core biopsy. Design.—Patients with a primary diagnosis of LCIS in a needle core biopsy who underwent subsequent excision were identified. Core biopsies containing a concurrent high-risk lesion and cases with radiologic-pathologic discordance were excluded. The presence of selected microscopic features in the needle core biopsy was correlated with pathologic upgrade. Microscopic findings were correlated with the radiographic target in the needle core biopsy. Results.—Sixty-one women with primary LCIS in their needle core biopsy showed a 10% pathologic upgrade rate. The percentage of cores involved by LCIS was significantly associated with pathologic upgrade (P= .04), whereas the remaining measured parameters were not. When LCIS represented the radiographic target, the pathologic upgrade rate was 18%, whereas when it was an incidental finding, the pathologic upgrade rate was 4%. Conclusions.—It may be reasonable for patients with primary, yet incidental, LCIS on needle core biopsy to be managed in a nonsurgical fashion. Larger studies are needed to confirm our findings.

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Atypical lobular hyperplasia and lobular carcinoma in situ at core needle biopsy of the breast: An incidental finding or are there characteristic imaging findings?

Breast Disease ◽

10.3233/bd-150194 ◽

2016 ◽

Vol 36 (1) ◽

pp. 5-14 ◽

Cited By ~ 4

Author(s):

Barry Amos ◽

Alison Chetlen ◽

Nicole Williams

Keyword(s):

Needle Biopsy ◽

Carcinoma In Situ ◽

Incidental Finding ◽

Lobular Carcinoma ◽

Imaging Findings ◽

Lobular Carcinoma In Situ ◽

Core Needle ◽

Atypical Lobular Hyperplasia ◽

Characteristic Imaging

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UK national survey of management of breast lobular carcinoma in situ

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2015.0037 ◽

2015 ◽

Vol 97 (8) ◽

pp. 574-577 ◽

Cited By ~ 5

Author(s):

R Chester ◽

O Bokinni ◽

I Ahmed ◽

A Kasem

Keyword(s):

Core Biopsy ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Surgery ◽

Lobular Carcinoma ◽

Surgical Excision ◽

National Standard ◽

Excision Biopsy ◽

Lobular Carcinoma In Situ

Introduction There is no national standard treatment for patients with breast lobular carcinoma in situ (LCIS). Association of Breast Surgery guidelines for the management of breast cancer suggest that lesions containing LCIS should be excised for definitive diagnosis and recommend close surveillance after excision biopsy. The aim of this study was to form a picture of the current management of LCIS by UK breast surgeons. Methods A questionnaire about the management of LCIS was sent to 490 UK breast surgeons. Results Of 490 questionnaires sent out, 173 (35%) were returned. When LCIS is present in a core biopsy, 61% of breast surgeons perform surgical excision, 22% would not excise but would continue follow-up and the remainder perform neither or set no clear management plan. Over half (54%) follow patients up with five years of annual mammography. If classic LCIS were found at the margins of wide local excision, 92% would not re-excise. Conversely, if pleomorphic LCIS were found, 71% would achieve clear margins. Respondents were split evenly regarding management of classic LCIS with a family history as 54% would not alter management whereas 43% would treat the disease more aggressively. Conclusions Our survey has shown that in cases where LCIS is found at core biopsy, most surgeons follow Association of Breast Surgery guidance, obtaining further histological samples to exclude pleomorphic LCIS, ductal carcinoma in situ or invasive cancer, whereas others opt for annual surveillance and some discharge the patient. This study highlighted the huge variability in LCIS management, and the need for randomised controlled trials and input into national audits such as the Sloane Project to establish evidence-based national standard guidelines.

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