J Breast Cancer.  2016 Jun;19(2):199-205. 10.4048/jbc.2016.19.2.199.

Features of Pure Lobular Carcinoma In Situ on Magnetic Resonance Imaging Associated with Immediate Re-Excision after Lumpectomy

• Chu AJ
• Cho N
• Park IA
• Cho SW

• KMID: 2308972
• DOI: http://doi.org/10.4048/jbc.2016.19.2.199

Abstract

PURPOSE
To evaluate imaging features of pure lobular carcinoma in situ (LCIS) on magnetic resonance imaging (MRI) in patients who underwent immediate re-excision after lumpectomy.
METHODS
Twenty-six patients (46.1±6.7 years) with 28 pure LCIS lesions, who underwent preoperative MRI and received curative surgery at our institution between 2005 and 2013, were included in this study. Clinicopathologic features associated with immediate re-excision were reviewed and analyzed using Fisher exact test or the Wilcoxon signed rank test.
RESULTS
Of the 28 lesions, 21.4% (6/28, six patients) were subjected to immediate re-excision due to resection margin involvement by LCIS. Nonmass lesions and moderate-to-marked background parenchymal enhancement on MRI were more frequently found in the re-excision group than in the single operation group (100% [6/6] vs. 40.9% [9/22], p=0.018; 83.3% [5/6] vs. 31.8% [7/22], p=0.057, respectively). The median lesion size discrepancy observed between magnetic resonance images and histopathology was greater in the re-excision group than in the single operation group (-0.82 vs. 0.13, p=0.018). There were no differences in the mammographic or histopathologic findings between the two groups.
CONCLUSION
Nonmass LCIS lesions or moderate-to-marked background parenchymal enhancements on MRI can result in an underestimation of the extent of the lesions and are associated with subsequent re-excision due to resection margin involvement.

Keyword

Breast neoplasms; Carcinoma in situ; Magnetic resonance imaging

MeSH Terms

Breast Neoplasms
Carcinoma in Situ
Carcinoma, Lobular*
Humans
Magnetic Resonance Imaging*
Mastectomy, Segmental*

Figure

• 

  Figure 1 Nonclassic lobular carcinoma in situ (LCIS) in 52-year-old woman who underwent re-excision due to resection margin involvement (case 10 in Table 1). (A) Mediolateral oblique magnification mammogram shows cluster of calcifications. (B) Ultrasonography shows an irregular, indistinct mass with calcifications (arrows). (C) Early contrast-enhanced sagittal magnetic resonance images shows regional, nonmass enhancement (arrows) in the moderate background parenchymal enhancement. (D) Photomicrograph of surgical specimen showing LCIS (arrows) adjacent to radial scar (H&E stain, ×10). (E) Photomicrograph of surgical specimen showing negative staining of E-cadherin in LCIS involving area (immunohistochemistry, ×10). (F) Photomicrograph of pleomorphic LCIS area showing pleomorphic cells and comedonecrosis (arrows) (H&E stain, ×40). The lesion was initially measured as 0.9 cm on magnetic resonance imaging. However, total LCIS extent including re-excision specimen was 8.7 cm.

• 

  Figure 2 Nonclassic lobular carcinoma in situ (LCIS) in 40-year-old woman who underwent single operation (case 2 in Table 1). (A) Mediolateral oblique magnification mammogram shows negative finding. Skin marker is placed for the mass found on ultrasonography (US). (B) US shows an irregular, indistinct mass (arrows) in the right upper breast. (C) Early contrast-enhanced sagittal magnetic resonance images shows an irregular mass (arrows) with homogeneous enhancement in the marked background parenchymal enhancement. The lesion shows fast rise and delayed washout enhancement pattern. (D) Photomicrograph of surgical specimen shows LCIS involving sclerosing adenosis (arrows) (H&E stain, ×10). (E) Photomicrograph of surgical specimen showing negative staining of E-cadherin in LCIS involving area (immunohistochemistry, ×10). The lesion was initially measured as 1.5 cm on magnetic resonance imaging. Lesion size on surgical histopathology was 2.0 cm.

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