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Annals of Surgical Oncology

, Volume 22, Issue 13, pp 4263–4269 | Cite as

Pleomorphic Lobular Carcinoma In Situ: Radiologic–Pathologic Features and Clinical Management

  • Meghan R. Flanagan
  • Mara H. Rendi
  • Kristine E. Calhoun
  • Benjamin O. Anderson
  • Sara H. Javid
Breast Oncology

Abstract

Background

Pleomorphic lobular carcinoma in situ (PLCIS) is an unusual variant of LCIS for which optimal management remains unclear.

Methods

We conducted a 15-year (2000–2014) retrospective chart review of the radiologic, pathologic, clinical management, and recurrence rates of patients with PLCIS on diagnostic biopsy. Fifty-one patients were found to have PLCIS either alone or with concomitant breast cancer. Of these, 23 were found to have pure PLCIS on diagnostic biopsy. Rates of upstaging after local excision, positive or close margins, mastectomy, and recurrence associated with pure pleomorphic lobular carcinoma in situ were examined.

Results

Of the 21 patients who underwent surgical excision following diagnostic biopsy, 33.3 % (7/21) were found to have invasive carcinoma, and 19 % (4/23) were found to have ductal carcinoma in situ. Extensive or multifocal PLCIS was present in 47.6 % (10/21) of patients, corresponding to at least one PLCIS-positive or close margin in 71.4 % (15/21). In total, there were 11 local re-excisions in nine patients, and 12 mastectomies. No ipsilateral breast cancer events have occurred, including in those with positive or close surgical margins (mean follow-up 4.1 years).

Conclusions

Patients with isolated PLCIS on diagnostic biopsy are at high risk of upgrading to invasive cancer or ductal carcinoma in situ at diagnostic excision. PLCIS often is extensive, with high rates of positive or close surgical resection margins. If negative PLCIS margins are pursued, rates of successful breast conservation are low. In light of this and low recurrence rates, caution should be exercised in aggressively treating PLCIS with excision to clear margins.

Keywords

National Comprehensive Cancer Network Invasive Lobular Carcinoma Excisional Biopsy Bilateral Mastectomy Close Margin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Washington School of Medicine.26 MRF was supported by T32 grant support from the National Cancer Institute under Award Number CA009168. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Disclosures

The authors report no disclosures or conflicts of interest.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Meghan R. Flanagan
    • 1
  • Mara H. Rendi
    • 2
  • Kristine E. Calhoun
    • 1
  • Benjamin O. Anderson
    • 1
  • Sara H. Javid
    • 1
  1. 1.Department of SurgeryUniversity of Washington Medical CenterSeattleUSA
  2. 2.Department of Anatomic PathologyUniversity of Washington Medical CenterSeattleUSA

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