Cancer Res Treat.  2022 Oct;54(4):1074-1080. 10.4143/crt.2021.864.

Lobular Carcinoma In Situ during Preoperative Biopsy and the Rate of Upgrade

• Lee J
• Ku GY
• Lee H
• Park HS
• Ku JS
• Kim JY
• Park S
• Park BW

• KMID: 2534186
• DOI: http://doi.org/10.4143/crt.2021.864

Abstract

Purpose
There is a potential risk that lobular carcinoma in situ (LCIS) on preoperative biopsy might be diagnosed as ductal carcinoma in situ (DCIS) or invasive carcinoma in the final pathology. This study aimed to evaluate the rate of upgrade of LCIS on preoperative biopsy to DCIS or invasive carcinoma.
Materials and Methods
Data of 55 patients with LCIS on preoperative biopsy were analyzed. All patients underwent surgery between 1991 and 2016 at Severance Hospital in Seoul, Korea. We analyzed the rate of upgrade of preoperative LCIS to DCIS or invasive cancer in the final pathology. The clinicopathologic features related to the upgrade were evaluated.
Results
The rate of upgrade of LCIS to DCIS or invasive carcinoma was 16.4% (9/55). In multivariate analysis, microcalcification and progesterone receptor expression were significantly associated with the upgrade of LCIS (p=0.023 and p=0.044, respectively).
Conclusion
The current study showed a relatively high rate of upgrade of LCIS on preoperative biopsy to DCIS or invasive cancer. The presence of microcalcification and progesterone receptor expression may be potential predictors of upgradation of LCIS on preoperative biopsy. Surgical excision of the LCIS during preoperative biopsy could be a management option to identify the concealed malignancy.

Keyword

Breast carcinoma; Breast neoplasms; Core needle biopsy; Lobular carcinoma; Surgical diagnostic technics

Figure

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  Fig. 1 Schema of the study design to analyze the upgrade rate of preoperative LCIS. DCIS, ductal carcinoma in situ; LCIS, lobular carcinoma in situ.

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  Fig. 2 The rate of upgrade of preoperative LCIS. (n=55). (A) The rate of upgrade of preoperative LCIS. (B) The rate of upgrade of preoperative LCIS according to the methods of preoperative biopsy. Bx, biopsy; CNB, core needle biopsy; LCIS, lobular carcinoma in situ; VAB, vacuum assisted biopsy.

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  Fig. 3 A case of the upgrade group with definite microcalcification on mammography without USG and MRI findings and the PR positivity. (A) Increased extent and amount of grouped microcalcification in lower central portion of the left breast on mammography. (B) Multiple probable benign enhancement without localized suspicious enhancements in both breasts on MRI. (C) Increased benign looking lesions in the both breasts on USG. MRI, magnetic resonance imaging; PR, progesterone receptor; USG, ultrasonography.

Reference

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