Lobular Carcinoma in Situ (LCIS)

By Priyanka Varma

BURLINGAME, Calif.

Jan. 26th, 2022

Lobular carcinoma in situ (LCIS) is the presence of atypical cells in the lobules of the breast which are the milk-producing glands at the end of breast ducts (Fig 1). 

LCIS is considered to be both a high risk factor and a non-obligate precursor of breast cancer [1]. LCIS is an incidental finding on breast biopsy and hence it is difficult to estimate its incidence [2]. Although LCIS is a relatively rare finding, it is seen in approximately 0.5% to 4% of benign breast biopsies [3]. One estimate is that the lifetime risk of developing invasive breast cancer is 30-40% for women with LCIS, versus a lifetime risk of 12.5% for the average woman [4]. A National Cancer database study identified that the median age of females diagnosed with LCIS was 52 years (range 21-90 years ) [5]. Older age was associated with a higher risk of subsequent development of breast cancer [6].

Histologically, in addition to classic LCIS, there can be two other varieties, pleomorphic and florid LCIS [7]. Pleomorphic and florid are also sometimes called “non-classic” or “variant” LCIS.

Earlier, mastectomy was recommended for LCIS patients; however, currently the preferred management is observation and active surveillance along with offered chemoprevention. The NCCN guidelines recommend a follow-up every 6 to 12 months with a physical exam as well as annual diagnostic mammogram for patients diagnosed with LCIS. Chemoprevention with Tamoxifen or aromatase inhibitors is shown to support risk reduction for breast cancer. LCIS has been removed from the tumor in situ category in the latest cancer staging system. Currently there is no consensus with respect to management recommendation for pleomorphic LCIS. It is recommended to exercise caution in an aggressive approach to management with excision till negative margins or performing mastectomy [1].

Bibliography:

1. Wen HY, Brogi E. Lobular Carcinoma In Situ. Surg Pathol Clin. 2018 Mar;11(1):123-145. doi: 10.1016/j.path.2017.09.009. Epub 2017 Dec 8. PMID: 29413653; PMCID: PMC5841603.
2. Wen HY, Brogi E. Lobular Carcinoma In Situ. Surg Pathol Clin. 2018 Mar;11(1):123-145. doi: 10.1016/j.path.2017.09.009. Epub 2017 Dec 8. PMID: 29413653; PMCID: PMC5841603
3. King TA, Pilewskie M, Muhsen S, et al. Lobular Carcinoma in Situ: A 29-Year Longitudinal Experience Evaluating Clinicopathologic Features and Breast Cancer Risk. J Clin Oncol. 2015;33(33):3945-3952. doi:10.1200/JCO.2015.61.4743
4. LCIS and Breast Cancer Risk
5. Taylor LJ, Steiman J, Schumacher JR, Wilke LG, Greenberg CC, Neuman HB. Surgical Management of Lobular Carcinoma In Situ: Analysis of the National Cancer Database. Ann Surg Oncol. 2018 Aug;25(8):2229-2234. doi: 10.1245/s10434-018-6495-5. Epub 2018 May 31. PMID: 29855831; PMCID: PMC6030479
6. Vora H, Kim S, Amersi F, Giuliano A, Chung A. Lobular Carcinoma In Situ: A 15-Year Single Institution Review. Am Surg. 2017 Oct 1;83(10):1040-1044. PMID: 29391091
7. Schnitt SJ, Brogi E, Chen YY, King TA, Lakhani SR. American Registry of Pathology Expert Opinions: The Spectrum of Lobular Carcinoma in Situ: Diagnostic Features and Clinical Implications. Ann Diagn Pathol. 2020;45:151481. doi:10.1016/j.anndiagpath.2020.151481

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