Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Dana-Farber/Harvard Cancer Center, Boston, MA, USA.
Ann Surg Oncol. 2019 Jan;26(1):55-61. doi: 10.1245/s10434-018-6937-0. Epub 2018 Oct 25.
A diagnosis of non-classic lobular carcinoma in situ (NC-LCIS) encompasses a variety of lesions with poorly characterized natural history. We evaluated upgrade rates and factors associated with upgrade to malignancy following a core biopsy diagnosis of NC-LCIS, and its natural history.
Upon Institutional Review Board approval, pathology databases were searched for NC-LCIS core biopsy diagnoses (carcinoma in situ [CIS], CIS with ductal and lobular features [CIS/DLF], pleomorphic LCIS [P-LCIS], variant LCIS [V-LCIS], LCIS with necrosis). Cases with available core and excision pathology were included, while cases with concurrent ipsilateral invasive carcinoma (IC), ductal carcinoma in situ (DCIS), and/or atypical ductal hyperplasia were excluded.
Overall, 121 NC-LCIS cases were identified from 1998 to 2017. We excluded 46 cases with concurrent cancer; 75 patients with 76 NC-LCIS core biopsy diagnoses followed by excision formed our study cohort. Median age was 56 years (range 41-83), and all imaging findings were classified as Breast Imaging Reporting and Data System 4; calcifications were the most common biopsy indication (80%). Excision yielded malignancy in 27 (36%) patients (IC 17, 63%; DCIS alone 10, 37%). We were unable to identify radiologic or pathologic features predictive of upgrade. Of 49 pure NC-LCIS cases, 15 (31%) had mastectomy, 9 (18%) had excision and radiation, and 25 (51%) had excision alone. At a median follow-up of 58 months (range 1-224), 1/25 (4%) patients with excision alone developed ipsilateral DCIS 14 months later.
In this series of NC-LCIS, 36% of cases were upgraded, supporting routine excision. We were unable to identify predictors of upgrade. Among 25 patients with pure NC-LCIS, only one patient developed a future ipsilateral cancer. Further study of the natural history of NC-LCIS is warranted.
非典型性小叶原位癌（NC-LCIS）的诊断涵盖了一系列具有特征性较差的自然病史的病变。我们评估了核心活检诊断为 NC-LCIS 后发生恶性肿瘤升级的发生率以及相关因素，以及其自然病史。
在机构审查委员会批准后，通过病理数据库搜索 NC-LCIS 核心活检诊断（原位癌[CIS]、CIS 伴导管和小叶特征[CIS/DLF]、多形性 LCIS[P-LCIS]、变异型 LCIS[V-LCIS]、伴坏死的 LCIS）。纳入有可用核心和切除病理的病例，而排除同侧同时存在浸润性癌（IC）、导管原位癌（DCIS）和/或不典型导管增生的病例。
总体而言，1998 年至 2017 年间共发现 121 例 NC-LCIS 病例。我们排除了 46 例同时存在癌症的病例；75 例患者共 76 例 NC-LCIS 核心活检诊断后进行了切除，形成了我们的研究队列。中位年龄为 56 岁（范围 41-83 岁），所有影像学表现均为乳腺影像报告和数据系统 4 级；钙化是最常见的活检指征（80%）。27 例（36%）患者切除后发现恶性肿瘤（IC17，63%；单纯 DCIS10，37%）。我们无法确定放射学或病理学特征可预测升级。在 49 例单纯性 NC-LCIS 病例中，15 例（31%）行乳房切除术，9 例（18%）行切除和放疗，25 例（51%）行单纯切除。在中位随访 58 个月（范围 1-224 个月）后，25 例单纯切除患者中有 1 例（4%）在 14 个月后发生同侧 DCIS。
在本系列 NC-LCIS 中，36%的病例发生升级，支持常规切除。我们无法确定升级的预测因素。在 25 例单纯性 NC-LCIS 患者中，仅有 1 例患者发生了同侧的未来癌症。需要进一步研究 NC-LCIS 的自然病史。
