Hoffman Daniel I, Zhang Paul J, Tchou Julia
Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Surg Oncol. 2019 Mar;28:190-194. doi: 10.1016/j.suronc.2019.01.009. Epub 2019 Jan 29.
Non-classic lobular carcinoma in situ (NC-LCIS) is a rare pre-cancer breast lesion that warrants excision to exclude invasive disease. In patients pursuing breast-conserving surgery (BCS) for NC-LCIS, the need for wide surgical margins is controversial. We characterized the outcomes of women diagnosed with NC-LCIS at a large, academic medical center.
Female patients seen at our institution from 2008 to 2018 with pure NC-LCIS were retrospectively identified. Patients were excluded if NC-LCIS was diagnosed in the background of invasive cancer or ductal carcinoma in situ. Clinicopathologic and follow-up data were collected. Rates of upstage, re-excision, and recurrence were calculated.
We identified 26 patients with pure NC-LCIS diagnosed on biopsy. 80.8% of patients initially pursued breast conservation, while 19.2% underwent mastectomy. At definitive surgery, 11.5% were upstaged. Among 19 non-upstaged patients that underwent BCS, 47.4% had at least one re-excision and 26.3% converted to mastectomy. In patients receiving BCS without completion mastectomy, 64.3% had final surgical margins that were negative for NC-LCIS, while 35.7% had positive or close margins. No recurrences in patients with negative margins were observed. One patient with positive margins developed a recurrence 8.3 years post-surgery, and one patient with close margins did 2.2 years post-surgery. All non-upstaged patients were alive at time of analysis with no evidence of invasive disease.
We presented the outcomes of one of the largest series of pure NC-LCIS. In patients with NC-LCIS pursuing breast conservation, re-excisions and completion mastectomies were common. However, when negative margins were achieved, prognosis was excellent.
非经典小叶原位癌（NC-LCIS）是一种罕见的癌前乳腺病变，需要切除以排除浸润性疾病。对于因NC-LCIS而接受保乳手术（BCS）的患者，是否需要宽手术切缘存在争议。我们对在一家大型学术医疗中心被诊断为NC-LCIS的女性患者的结局进行了特征分析。
回顾性确定2008年至2018年在我们机构就诊的患有单纯NC-LCIS的女性患者。如果NC-LCIS是在浸润性癌或导管原位癌背景下诊断的，则将患者排除。收集临床病理和随访数据。计算分期升级、再次切除和复发率。
我们确定了26例经活检诊断为单纯NC-LCIS的患者。80.8%的患者最初选择保乳，而19.2%的患者接受了乳房切除术。在确定性手术时，11.5%的患者分期升级。在19例未分期升级且接受BCS的患者中，47.4%至少进行了一次再次切除，26.3%转为乳房切除术。在未完成乳房切除术而接受BCS的患者中，64.3%的最终手术切缘对NC-LCIS呈阴性，而35.7%的切缘呈阳性或接近阳性。切缘阴性的患者未观察到复发。一名切缘阳性的患者在术后8.3年出现复发，一名切缘接近阳性的患者在术后2.2年出现复发。所有未分期升级的患者在分析时均存活，无浸润性疾病证据。
我们展示了最大系列之一的单纯NC-LCIS的结局。对于因NC-LCIS而选择保乳的患者，再次切除和完成乳房切除术很常见。然而，当切缘阴性时，预后极佳。
