Fisher Edwin R, Land Stephanie R, Fisher Bernard, Mamounas Eleftherios, Gilarski Linda, Wolmark Norman
Pathology Center, National Surgical Adjuvant Breast and Bowel Project Pathology Center, Pittsburgh, Pennsylvania, USA.
Cancer. 2004 Jan 15;100(2):238-44. doi: 10.1002/cncr.11883.
The current report represents a 12-year clinicopathologic update of an earlier 5-year analysis of 180 patients with lobular carcinoma in situ (LCIS) who were treated with local excision and subsequent surveillance only.
Nineteen pathologic characteristics of LCIS were assessed as potential predictors of invasive and noninvasive ipsilateral breast tumor recurrence (IBTR) and contralateral breast tumor recurrence (CBTR) as well as mortality.
Overall, only 26 IBTRs (14.4%) and 14 CBTRs (7.8%) were observed. Nine IBTRs (5.0% of the total cohort) and 10 CBTRs (5.6% of the total cohort) were invasive carcinomas. Eight of 9 IBTRs (88.9%) and 6 of 8 invasive CBTRs (75%) that had histologic sections available for review were of the lobular invasive type. Ninety-six percent of all IBTRs and 100% of invasive IBTRs occurred within the same site as the index LCIS. The numbers of invasive IBTRs were comparable within and after 5 years (5 invasive IBTRs vs. 4 IBTRs). Recurrences of invasive CBTR occurred later than recurrences of invasive IBTR, with 70% of invasive CBTRs recognized after 5 years compared with 44% of invasive IBTRs. It was found that Grade 2-3 LCIS was significantly predictive for invasive IBTR when combined with the number of recurrences of ductal carcinoma in situ (DCIS) alone or with LCIS. Only 2 patients in the cohort (1.1%) succumbed to breast carcinoma; 1 patient had a prior invasive IBTR, and the other patient had an invasive CBTR. The reasons for the lower frequency of invasive recurrences and the higher proportions of the lobular invasive phenotype than noted by others are discussed along with the impact of the findings on the nomenclature, precursor nature, and treatment of LCIS.
LCIS is a more indolent form of in situ breast carcinoma than DCIS, with which it shares other features of its natural history, particularly very low mortality rates. There is no compelling reason to surgically treat LCIS other than conservatively. The values of other adjuvant modalities in the management of LCIS are discussed. The authors acknowledge that their findings are based on relatively few events and, even at 12 years, may be regarded as "preliminary". Nonetheless, their findings may reflect the true biologic nature of LCIS.
本报告是对180例小叶原位癌（LCIS）患者进行的一项为期12年的临床病理更新，这些患者仅接受了局部切除及后续监测，早期曾有过一项为期5年的分析。
评估了LCIS的19项病理特征，作为同侧乳腺浸润性和非浸润性肿瘤复发（IBTR）、对侧乳腺肿瘤复发（CBTR）以及死亡率的潜在预测指标。
总体而言，仅观察到26例IBTR（14.4%）和14例CBTR（7.8%）。9例IBTR（占总队列的5.0%）和10例CBTR（占总队列的5.6%）为浸润性癌。9例IBTR中的8例（88.9%）以及8例浸润性CBTR中的6例（75%）有组织学切片可供复查，均为小叶浸润型。所有IBTR中的96%以及浸润性IBTR中的100%发生在与索引LCIS相同的部位。5年内及5年后浸润性IBTR的数量相当（5例浸润性IBTR对4例IBTR）。浸润性CBTR的复发比浸润性IBTR的复发更晚，5年后70%的浸润性CBTR被发现，而浸润性IBTR为44%。发现2-3级LCIS与单纯导管原位癌（DCIS）或LCIS的复发数量相结合时，对浸润性IBTR具有显著预测性。队列中仅有2例患者（1.1%）死于乳腺癌；1例患者曾有浸润性IBTR，另1例患者有浸润性CBTR。讨论了浸润性复发频率较低以及小叶浸润型比例高于其他人所报道的原因，以及这些发现对LCIS的命名、前驱性质和治疗的影响。
与DCIS相比，LCIS是一种更惰性的乳腺原位癌形式，它在自然史的其他特征上与之相似，尤其是死亡率非常低。除了保守治疗外，没有令人信服的理由对LCIS进行手术治疗。讨论了其他辅助治疗方式在LCIS管理中的价值。作者承认他们的发现基于相对较少的事件，即使在12年后，也可能被视为“初步的”。尽管如此，他们的发现可能反映了LCIS的真正生物学性质。
