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The Florid Subtype of Lobular Carcinoma In Situ: Marker or Precursor for Invasive Lobular Carcinoma?

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

Abstract

Background

Lobular carcinoma in situ (LCIS) is considered a risk factor—not a precursor—for both invasive lobular and ductal carcinoma. Florid LCIS (F-LCIS) is an architectural subtype of LCIS that does not express E-cadherin, yet has the histologic and often radiographic appearance of solid-type ductal carcinoma in situ (DCIS). Since DCIS is considered a precursor to invasive ductal carcinoma, should F-LCIS be considered a precursor to invasive lobular carcinoma (ILC)?

Methods

Review of an institutional database identified cases of LCIS and solid-type DCIS diagnosed by excisional biopsy, segmentectomy, or mastectomy between 1991 and 2000 to determine the prevalence of associated invasive breast cancer. Archival specimens were evaluated for florid and nonflorid LCIS, nuclear grade of LCIS, and the presence and subtype of invasive breast cancer. Solid-type DCIS that lacked E-cadherin expression was classified as F-LCIS.

Results

Of 210 consecutive specimens of LCIS examined, 171 had nonflorid LCIS (81%) and 39 had F-LCIS (19%). Nonflorid LCIS had a diffuse pattern, whereas F-LCIS appeared as discrete foci adjacent to ILC. An invasive component was identified with 87% of F-LCIS lesions versus 73% of nonflorid LCIS lesions (P = 0.064); this component was lobular in 100% of F-LCIS lesions versus 82% of nonflorid LCIS lesions, a significant difference (P = 0.0044) that persisted when the analysis was adjusted for nuclear grade (P = 0.0082).

Conclusion

Its close spatial relationship to an invasive component and increased association with ILC suggest that F-LCIS may be a precursor for ILC.

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Acknowledgment

Supported by funding from the Margie and Robert E. Petersen Foundation (Los Angeles, CA), QVC and the Fashion Footwear Association of New York Charitable Foundation (New York, NY), Mrs. Lois Rosen (Los Angeles, CA), the Associates for Breast and Prostate Cancer Studies (Santa Monica, CA), Maria Lucia and Fernando Diez Barroso (Beverly Hills, CA), the Ruth and Martin H. Weil Fund (Los Angeles, CA), the Lance Armstrong Foundation (Austin, TX), the John Wayne Cancer Foundation (Newport Beach, CA), the Wrather Family Foundation (Los Alamos, CA), the Samueli Foundation (Corona Del Mar, CA) [Dr. Bagaria], and the Harold H. McAlister Charitable Foundation (Los Angeles, CA) [Dr. Ray].

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Author notes

  1. Sanjay P. Bagaria MD

    Present address: Mayo Clinic, Jacksonville, FL, USA

  2. Partha S. Ray MD

    Present address: University of Illinois, Urbana-Champaign, IL, USA

Authors and Affiliations

  1. Department of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA, USA

    Sanjay P. Bagaria MD, Partha S. Ray MD & Armando E. Giuliano MD

  2. Department of Pathology, Saint John’s Health Center, Santa Monica, CA, USA

    Jaime Shamonki MD & Michelle Kinnaird MHS

Authors
  1. Sanjay P. Bagaria MD
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  2. Jaime Shamonki MD
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  3. Michelle Kinnaird MHS
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  4. Partha S. Ray MD
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  5. Armando E. Giuliano MD
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Correspondence to Armando E. Giuliano MD.

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Bagaria, S.P., Shamonki, J., Kinnaird, M. et al. The Florid Subtype of Lobular Carcinoma In Situ: Marker or Precursor for Invasive Lobular Carcinoma?. Ann Surg Oncol 18, 1845–1851 (2011). https://doi.org/10.1245/s10434-011-1563-0

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  • DOI: https://doi.org/10.1245/s10434-011-1563-0

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