Meurs Claudia J C, Kerkhoven Crystal, Siesling Sabine, Menke-Pluijmers Marian B E, Westenend Pieter J
Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
CMAnalyzing, Zevenaar, The Netherlands.
Ann Surg Oncol. 2025 Apr;32(4):2545-2553. doi: 10.1245/s10434-024-16686-8. Epub 2024 Dec 30.
The Dutch breast cancer guideline recommends surveillance for classic lobular carcinoma in situ (LCIS), unless there is a discrepancy with mammographic findings, and surgery for pleomorphic and non-classic LCIS.
The aim of this study was to assess adherence to the guideline in daily practice, as well as the surgery rate, risk of upstaging, and events during follow-up.
Selection of patients from a nationwide cohort diagnosed between 2011 and 2020. Patients with a history of in situ or invasive breast cancer or concomitant atypical ductal hyperplasia were excluded. Analyses comprised univariable analysis.
Of 1178 diagnoses, 1018 (86%) were classic LCIS, 129 (11%) were pleomorphic LCIS, and 31 (3%) were non-classic (florid or unspecified non-classic) LCIS. Surgery was performed in 323 patients. The surgery rate for classic LCIS was 19%, 83% for pleomorphic LCIS, and 84% for non-classic LCIS. The upstage rate for both classic and pleomorphic LCIS was 32%, and 31% for non-classic LCIS. LCIS was upstaged in 103 patients (32%); 24 (7%) to DCIS and 79 (25%) to invasive breast cancer. Follow-up of the 859 non-operated patients showed fewer than 4% with ipsilateral DCIS or invasive breast cancer.
The surgery rates for classic, pleomorphic, and non-classic LCIS indicate that the guideline is well adhered to in daily practice. Given the high upstage rates and low number of subsequent DCIS and invasive breast cancer events in patients with classic LCIS, these patients appear to be well-selected for surgery versus surveillance. The results support the recommendation to operate on patients with pleomorphic/non-classic LCIS.
荷兰乳腺癌指南建议对经典型小叶原位癌（LCIS）进行监测，除非与乳腺钼靶检查结果存在差异，而对于多形性和非经典型LCIS则建议进行手术。
本研究旨在评估日常实践中对该指南的遵循情况，以及手术率、分期升级风险和随访期间的事件。
从2011年至2020年确诊的全国性队列中选取患者。排除有原位或浸润性乳腺癌病史或合并非典型导管增生的患者。分析包括单变量分析。
在1178例诊断中，1018例（86%）为经典型LCIS，129例（11%）为多形性LCIS，31例（3%）为非经典型（ florid或未明确的非经典型）LCIS。323例患者接受了手术。经典型LCIS的手术率为19%，多形性LCIS为83%，非经典型LCIS为84%。经典型和多形性LCIS的分期升级率均为32%，非经典型LCIS为31%。103例患者（32%）的LCIS分期升级；24例（7%）升级为导管原位癌（DCIS），79例（25%）升级为浸润性乳腺癌。对859例未手术患者的随访显示，同侧DCIS或浸润性乳腺癌患者少于4%。
经典型、多形性和非经典型LCIS的手术率表明，日常实践中对该指南的遵循情况良好。鉴于经典型LCIS患者的分期升级率高，以及随后发生DCIS和浸润性乳腺癌事件的数量少，这些患者似乎在手术与监测方面选择得当。结果支持对多形性/非经典型LCIS患者进行手术的建议。
