Department of Surgical Oncology, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.
Ann Surg Oncol. 2011 Jul;18(7):1845-51. doi: 10.1245/s10434-011-1563-0. Epub 2011 Feb 2.
Lobular carcinoma in situ (LCIS) is considered a risk factor-not a precursor-for both invasive lobular and ductal carcinoma. Florid LCIS (F-LCIS) is an architectural subtype of LCIS that does not express E-cadherin, yet has the histologic and often radiographic appearance of solid-type ductal carcinoma in situ (DCIS). Since DCIS is considered a precursor to invasive ductal carcinoma, should F-LCIS be considered a precursor to invasive lobular carcinoma (ILC)?
Review of an institutional database identified cases of LCIS and solid-type DCIS diagnosed by excisional biopsy, segmentectomy, or mastectomy between 1991 and 2000 to determine the prevalence of associated invasive breast cancer. Archival specimens were evaluated for florid and nonflorid LCIS, nuclear grade of LCIS, and the presence and subtype of invasive breast cancer. Solid-type DCIS that lacked E-cadherin expression was classified as F-LCIS.
Of 210 consecutive specimens of LCIS examined, 171 had nonflorid LCIS (81%) and 39 had F-LCIS (19%). Nonflorid LCIS had a diffuse pattern, whereas F-LCIS appeared as discrete foci adjacent to ILC. An invasive component was identified with 87% of F-LCIS lesions versus 73% of nonflorid LCIS lesions (P = 0.064); this component was lobular in 100% of F-LCIS lesions versus 82% of nonflorid LCIS lesions, a significant difference (P = 0.0044) that persisted when the analysis was adjusted for nuclear grade (P = 0.0082).
Its close spatial relationship to an invasive component and increased association with ILC suggest that F-LCIS may be a precursor for ILC.
乳腺小叶原位癌（LCIS）被认为是浸润性小叶癌和导管癌的危险因素，而非前体。富于细胞型 LCIS（F-LCIS）是 LCIS 的一种结构亚型，不表达 E-钙黏蛋白，但具有实性型导管原位癌（DCIS）的组织学和通常的影像学表现。由于 DCIS 被认为是浸润性导管癌的前体，那么 F-LCIS 是否也应该被认为是浸润性小叶癌（ILC）的前体呢？
回顾性分析了 1991 年至 2000 年期间通过切除术、节段切除术或乳房切除术诊断的 LCIS 和实性 DCIS 的机构数据库，以确定相关浸润性乳腺癌的患病率。评估存档标本中的富于细胞型和非富于细胞型 LCIS、LCIS 的核级以及浸润性乳腺癌的存在和亚型。缺乏 E-钙黏蛋白表达的实性 DCIS 被归类为 F-LCIS。
在检查的 210 例连续 LCIS 标本中，171 例为非富于细胞型 LCIS（81%），39 例为 F-LCIS（19%）。非富于细胞型 LCIS 呈弥漫性模式，而 F-LCIS 则表现为与 ILC 相邻的离散灶。F-LCIS 病变中 87%有浸润成分，而非富于细胞型 LCIS 病变中为 73%（P = 0.064）；F-LCIS 病变中浸润成分全部为小叶癌，而非富于细胞型 LCIS 病变中为 82%，差异有统计学意义（P = 0.0044），当分析调整核级时，差异仍然具有统计学意义（P = 0.0082）。
F-LCIS 与浸润成分的密切空间关系以及与 ILC 的更高关联提示其可能是 ILC 的前体。
