Ciocca Robin M, Li Tianyu, Freedman Gary M, Morrow Monica
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Ann Surg Oncol. 2008 Aug;15(8):2263-71. doi: 10.1245/s10434-008-9960-8. Epub 2008 May 28.
Lobular carcinoma in situ (LCIS) is known to be a risk factor for the development of invasive breast cancer. Debate continues as to whether LCIS is also a precursor lesion. We hypothesized that, if LCIS were a precursor, its presence in the lumpectomy specimen, particularly at the margin, could increase local recurrence (LR) after breast-conserving therapy (BCT).
2894 patients treated with BCT for ductal carcinoma in situ (DCIS), stage I or II breast cancer between 1/80 and 5/07 were identified. Patients with DCIS or invasive cancer at the margins or those receiving neoadjuvant therapy were excluded. Group A had 290 patients with LCIS in the lumpectomy; 84 had LCIS at the final margin. Group B included 2604 patients with no evidence of LCIS.
Median patient age in group A and B was 57 and 58 years, respectively (P = 0.05); 12% and 13%, respectively, of patients in group A and B had margins <2 mm (P = NS). The histologic distribution of tumor types in group A was lobular in 47.2%, ductal in 34.5%, DCIS in 11.4%, and other invasive histologies in 6.9%, compared with 4.1%, 76.3%,13.6%, and 6.0% for group B, respectively (P < 0.0001). There was no significant difference between the groups in tumor-node-metastasis (TNM) stage. The crude rate of LR was 4.5% in group A and 3.8% in group B (P = NS). Five- and 10-year actuarial LR rates for LCIS at the margin were 6% and 6%, 1% and 15% for LCIS present but not at the margin, and 2% and 6% for no LCIS (P = NS), for group A and B, respectively. In multivariate analysis, menopausal status and adjuvant therapy use were significant predictors of LR. LCIS, either in the specimen or at the margin, was not significantly associated with LR.
Presence of LCIS, even at the margin, in BCT specimens does not have an impact on LR. Re-excision is not indicated if LCIS is present or close to margin surfaces. These findings do not support consideration of LCIS as a precursor to the development of invasive lesions.
小叶原位癌（LCIS）是浸润性乳腺癌发生的已知危险因素。关于LCIS是否也是一种前驱病变仍存在争议。我们假设，如果LCIS是一种前驱病变，其在乳房肿瘤切除术标本中的存在，尤其是在切缘处，可能会增加保乳治疗（BCT）后的局部复发（LR）。
确定了1980年1月至2007年5月期间接受BCT治疗导管原位癌（DCIS）、I期或II期乳腺癌的2894例患者。排除切缘有DCIS或浸润性癌的患者或接受新辅助治疗的患者。A组有290例乳房肿瘤切除术中发现LCIS的患者；84例最终切缘有LCIS。B组包括2604例无LCIS证据的患者。
A组和B组患者的中位年龄分别为57岁和58岁（P = 0.05）；A组和B组分别有12%和13%的患者切缘<2 mm（P =无显著性差异）。A组肿瘤类型的组织学分布为小叶癌占47.2%，导管癌占34.5%，DCIS占11.4%，其他浸润性组织学类型占6.9%，而B组分别为4.1%、76.3%、13.6%和
