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Published in: Annals of Surgical Oncology 10/2023

26-07-2023 | Breast Cancer | Breast Oncology

Does Non-Classic Lobular Carcinoma In Situ at the Lumpectomy Margin Increase Local Recurrence?

Authors: Anna C. Beck, MD, Solange Bayard, MD, George Plitas, MD, Varadan Sevilimedu, MBBS, DrPH, M. Gabriela Kuba, MD, Paula Garcia, MHA, Monica Morrow, MD, Audree B. Tadros, MD, MPH

Published in: Annals of Surgical Oncology | Issue 10/2023

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Abstract

Background

The clinical significance of nonclassic, lobular carcinoma in situ (NC-LCIS) at the surgical margin of excisions for invasive cancer is unknown. We sought to determine whether NC-LCIS at or near the margin in the setting of a concurrent invasive carcinoma is associated with risk of ipsilateral breast tumor recurrence (IBTR) and locoregional recurrence (LRR).

Methods

Patients with stage 0-III breast cancer and NC-LCIS who underwent lumpectomy between January 2010 and January 2022 at a single institution were retrospectively identified. NC-LCIS margins were stratified as <2 mm, ≥2 mm, or within shave margin. Rates of IBTR and LRR were examined.

Results

A total of 511 female patients (median age 60 years [interquartile range (IQR) 52–69]) with NC-LCIS and an associated ipsilateral breast cancer with a median follow-up of 3.4 years (IQR 2.0–5.9) were identified. Final margins for NC-LCIS were ≥2 mm in 348 patients (68%), <2 mm in 37 (7.2%), and within shave margin in 126 (24.6%). Crude incidence of IBTR was 3.3% (n = 17) and that of LRR was 4.9% (n = 25). There was no difference in the crude rate of IBTR by NC-LCIS margin status (IBTR rate: 3.7% ≥2 mm, 0% <2 mm, 3.2% within shave margin, p = 0.8) nor in LRR (LRR rate: 4.9% ≥2 mm, 2.7% <2 mm, 5.6% within shave margin, p = 0.9).

Conclusions

For completely excised invasive breast cancers associated with NC-LCIS, extent of margin width for NC-LCIS was not associated with a difference in IBTR or LRR. These data suggest that the decision to perform reexcision of margin after lumpectomy should be driven by the invasive cancer, rather than the NC-LCIS margin.
Literature
1.
go back to reference Atkins KA, Cohen MA, Nicholson B, Rao S. Atypical lobular hyperplasia and lobular carcinoma in situ at core breast biopsy: use of careful radiologic-pathologic correlation to recommend excision or observation. Radiology. 2013;269(2):340–7.CrossRefPubMed Atkins KA, Cohen MA, Nicholson B, Rao S. Atypical lobular hyperplasia and lobular carcinoma in situ at core breast biopsy: use of careful radiologic-pathologic correlation to recommend excision or observation. Radiology. 2013;269(2):340–7.CrossRefPubMed
2.
go back to reference Chaudhary S, Lawrence L, McGinty G, Kostroff K, Bhuiya T. Classic lobular neoplasia on core biopsy: a clinical and radio-pathologic correlation study with follow-up excision biopsy. Mod Pathol. 2013;26(6):762–71.CrossRefPubMed Chaudhary S, Lawrence L, McGinty G, Kostroff K, Bhuiya T. Classic lobular neoplasia on core biopsy: a clinical and radio-pathologic correlation study with follow-up excision biopsy. Mod Pathol. 2013;26(6):762–71.CrossRefPubMed
3.
go back to reference D’Alfonso TM, Wang K, Chiu YL, Shin SJ. Pathologic upgrade rates on subsequent excision when lobular carcinoma in situ is the primary diagnosis in the needle core biopsy with special attention to the radiographic target. Arch Pathol Lab Med. 2013;137(7):927–35.CrossRefPubMed D’Alfonso TM, Wang K, Chiu YL, Shin SJ. Pathologic upgrade rates on subsequent excision when lobular carcinoma in situ is the primary diagnosis in the needle core biopsy with special attention to the radiographic target. Arch Pathol Lab Med. 2013;137(7):927–35.CrossRefPubMed
4.
go back to reference Murray MP, Luedtke C, Liberman L, Nehhozina T, Akram M, Brogi E. Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: outcomes of prospective excision. Cancer. 2013;119(5):1073–9.CrossRefPubMed Murray MP, Luedtke C, Liberman L, Nehhozina T, Akram M, Brogi E. Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: outcomes of prospective excision. Cancer. 2013;119(5):1073–9.CrossRefPubMed
5.
go back to reference Rendi MH, Dintzis SM, Lehman CD, Calhoun KE, Allison KH. Lobular in-situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. Ann Surg Oncol. 2012;19(3):914–21.CrossRefPubMed Rendi MH, Dintzis SM, Lehman CD, Calhoun KE, Allison KH. Lobular in-situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. Ann Surg Oncol. 2012;19(3):914–21.CrossRefPubMed
6.
go back to reference Shah-Khan MG, Geiger XJ, Reynolds C, Jakub JW, Deperi ER, Glazebrook KN. Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. Ann Surg Oncol. 2012;19(10):3131–8.CrossRefPubMed Shah-Khan MG, Geiger XJ, Reynolds C, Jakub JW, Deperi ER, Glazebrook KN. Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. Ann Surg Oncol. 2012;19(10):3131–8.CrossRefPubMed
7.
go back to reference Zhao C, Desouki MM, Florea A, Mohammed K, Li X, Dabbs D. Pathologic findings of follow-up surgical excision for lobular neoplasia on breast core biopsy performed for calcification. Am J Clin Pathol. 2012;138(1):72–8.CrossRefPubMed Zhao C, Desouki MM, Florea A, Mohammed K, Li X, Dabbs D. Pathologic findings of follow-up surgical excision for lobular neoplasia on breast core biopsy performed for calcification. Am J Clin Pathol. 2012;138(1):72–8.CrossRefPubMed
8.
go back to reference World Health Organization. Breast tumours. Vol 2. 5th edn. (2019). World Health Organization. Breast tumours. Vol 2. 5th edn. (2019).
9.
go back to reference Tan PH, Ellis I, Allison K, et al. The 2019 world health organization classification of tumours of the breast. Histopathology. 2020;77(2):181–5.CrossRefPubMed Tan PH, Ellis I, Allison K, et al. The 2019 world health organization classification of tumours of the breast. Histopathology. 2020;77(2):181–5.CrossRefPubMed
10.
go back to reference De Brot M, Koslow Mautner S, Muhsen S, et al. Pleomorphic lobular carcinoma in situ of the breast: a single institution experience with clinical follow-up and centralized pathology review. Breast Cancer Res Treat. 2017;165(2):411–20.CrossRefPubMedPubMedCentral De Brot M, Koslow Mautner S, Muhsen S, et al. Pleomorphic lobular carcinoma in situ of the breast: a single institution experience with clinical follow-up and centralized pathology review. Breast Cancer Res Treat. 2017;165(2):411–20.CrossRefPubMedPubMedCentral
11.
go back to reference Desai AA, Jimenez RE, Hoskin TL, Day CN, Boughey JC, Hieken TJ. Treatment outcomes for pleomorphic lobular carcinoma in situ of the breast. Ann Surg Oncol. 2018;25(10):3064–8.CrossRefPubMed Desai AA, Jimenez RE, Hoskin TL, Day CN, Boughey JC, Hieken TJ. Treatment outcomes for pleomorphic lobular carcinoma in situ of the breast. Ann Surg Oncol. 2018;25(10):3064–8.CrossRefPubMed
12.
go back to reference Guo T, Wang Y, Shapiro N, Fineberg S. Pleomorphic lobular carcinoma in situ diagnosed by breast core biopsy: clinicopathologic features and correlation with subsequent excision. Clin Breast Cancer. 2018;18(4):e449–54.CrossRefPubMed Guo T, Wang Y, Shapiro N, Fineberg S. Pleomorphic lobular carcinoma in situ diagnosed by breast core biopsy: clinicopathologic features and correlation with subsequent excision. Clin Breast Cancer. 2018;18(4):e449–54.CrossRefPubMed
13.
go back to reference Khoury T, Kumar PR, Li Z, et al. Lobular neoplasia detected in MRI-guided core biopsy carries a high risk for upgrade: a study of 63 cases from four different institutions. Mod Pathol. 2016;29(1):25–33.CrossRefPubMed Khoury T, Kumar PR, Li Z, et al. Lobular neoplasia detected in MRI-guided core biopsy carries a high risk for upgrade: a study of 63 cases from four different institutions. Mod Pathol. 2016;29(1):25–33.CrossRefPubMed
14.
go back to reference Kuba MG, Murray MP, Coffey K, Calle C, Morrow M, Brogi E. Morphologic subtypes of lobular carcinoma in situ diagnosed on core needle biopsy: clinicopathologic features and findings at follow-up excision. Mod Pathol. 2021;34(8):1495–506.CrossRefPubMedPubMedCentral Kuba MG, Murray MP, Coffey K, Calle C, Morrow M, Brogi E. Morphologic subtypes of lobular carcinoma in situ diagnosed on core needle biopsy: clinicopathologic features and findings at follow-up excision. Mod Pathol. 2021;34(8):1495–506.CrossRefPubMedPubMedCentral
15.
go back to reference Middleton LP, Grant S, Stephens T, Stelling CB, Sneige N, Sahin AA. Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised? Mod Pathol. 2003;16(2):120–9.CrossRefPubMed Middleton LP, Grant S, Stephens T, Stelling CB, Sneige N, Sahin AA. Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised? Mod Pathol. 2003;16(2):120–9.CrossRefPubMed
16.
go back to reference Nakhlis F, Harrison BT, Giess CS, et al. Evaluating the rate of upgrade to invasive breast cancer and/or ductal carcinoma in situ following a core biopsy diagnosis of non-classic lobular carcinoma in situ. Ann Surg Oncol. 2019;26(1):55–61.CrossRefPubMed Nakhlis F, Harrison BT, Giess CS, et al. Evaluating the rate of upgrade to invasive breast cancer and/or ductal carcinoma in situ following a core biopsy diagnosis of non-classic lobular carcinoma in situ. Ann Surg Oncol. 2019;26(1):55–61.CrossRefPubMed
17.
go back to reference Flanagan MR, Rendi MH, Calhoun KE, Anderson BO, Javid SH. Pleomorphic lobular carcinoma in situ: radiologic-pathologic features and clinical management. Ann Surg Oncol. 2015;22(13):4263–9.CrossRefPubMedPubMedCentral Flanagan MR, Rendi MH, Calhoun KE, Anderson BO, Javid SH. Pleomorphic lobular carcinoma in situ: radiologic-pathologic features and clinical management. Ann Surg Oncol. 2015;22(13):4263–9.CrossRefPubMedPubMedCentral
18.
go back to reference National Comprehensive Cancer Network (NCCN). Breast cancer. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) 4.2023. Accessed 16 April 2023. National Comprehensive Cancer Network (NCCN). Breast cancer. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) 4.2023. Accessed 16 April 2023.
19.
go back to reference Blair SL, Emerson DK, Kulkarni S, Hwang ES, Malcarne V, Ollila DW. Breast surgeon’s survey: no consensus for surgical treatment of pleomorphic lobular carcinoma in situ. Breast J. 2013;19(1):116–8.CrossRefPubMed Blair SL, Emerson DK, Kulkarni S, Hwang ES, Malcarne V, Ollila DW. Breast surgeon’s survey: no consensus for surgical treatment of pleomorphic lobular carcinoma in situ. Breast J. 2013;19(1):116–8.CrossRefPubMed
20.
go back to reference Moo TA, Choi L, Culpepper C, et al. Impact of margin assessment method on positive margin rate and total volume excised. Ann Surg Oncol. 2014;21(1):86–92.CrossRefPubMed Moo TA, Choi L, Culpepper C, et al. Impact of margin assessment method on positive margin rate and total volume excised. Ann Surg Oncol. 2014;21(1):86–92.CrossRefPubMed
21.
go back to reference Schnitt SJ, Brogi E, Chen YY, King TA, Lakhani SR. American registry of pathology expert opinions: the spectrum of lobular carcinoma in situ: diagnostic features and clinical implications. Ann Diagn Pathol. 2020;45:151481.CrossRefPubMedPubMedCentral Schnitt SJ, Brogi E, Chen YY, King TA, Lakhani SR. American registry of pathology expert opinions: the spectrum of lobular carcinoma in situ: diagnostic features and clinical implications. Ann Diagn Pathol. 2020;45:151481.CrossRefPubMedPubMedCentral
22.
go back to reference Moran Meena S, et al. SSO-ASTRO consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stage I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014;88(3):553.CrossRefPubMedPubMedCentral Moran Meena S, et al. SSO-ASTRO consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stage I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014;88(3):553.CrossRefPubMedPubMedCentral
23.
go back to reference Morrow M, et al. Society of surgical oncology-American society for radiation oncology-American society of clinical oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Pract Radiat Oncol. 2016;6.5:287–95.CrossRef Morrow M, et al. Society of surgical oncology-American society for radiation oncology-American society of clinical oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Pract Radiat Oncol. 2016;6.5:287–95.CrossRef
24.
go back to reference Ciocca RM, Li T, Freedman GM, Morrow M. Presence of lobular carcinoma in situ does not increase local recurrence in patients treated with breast-conserving therapy. Ann Surg Oncol. 2008;15(8):2263–71.CrossRefPubMedPubMedCentral Ciocca RM, Li T, Freedman GM, Morrow M. Presence of lobular carcinoma in situ does not increase local recurrence in patients treated with breast-conserving therapy. Ann Surg Oncol. 2008;15(8):2263–71.CrossRefPubMedPubMedCentral
25.
go back to reference Shamir ER, Chen YY, Chu T, Pekmezci M, Rabban JT, Krings G. Pleomorphic and florid lobular carcinoma in situ variants of the breast: A clinicopathologic study of 85 cases with and without invasive carcinoma from a single academic center. Am J Surg Pathol. 2019;43(3):399–408.CrossRefPubMed Shamir ER, Chen YY, Chu T, Pekmezci M, Rabban JT, Krings G. Pleomorphic and florid lobular carcinoma in situ variants of the breast: A clinicopathologic study of 85 cases with and without invasive carcinoma from a single academic center. Am J Surg Pathol. 2019;43(3):399–408.CrossRefPubMed
26.
go back to reference Brock J. Lobular carcinoma in situ: A pragmatic approach to the controversies. Hum Pathol Rep. 2022;27. Brock J. Lobular carcinoma in situ: A pragmatic approach to the controversies. Hum Pathol Rep. 2022;27.
27.
go back to reference Downs-Kelly E, Bell D, Perkins GH, Sneige N, Middleton LP. Clinical implications of margin involvement by pleomorphic lobular carcinoma in situ. Arch Pathol Lab Med. 2011;135(6):737–43.CrossRefPubMed Downs-Kelly E, Bell D, Perkins GH, Sneige N, Middleton LP. Clinical implications of margin involvement by pleomorphic lobular carcinoma in situ. Arch Pathol Lab Med. 2011;135(6):737–43.CrossRefPubMed
28.
go back to reference Khoury T, Karabakhtsian RG, Mattson D, et al. Pleomorphic lobular carcinoma in situ of the breast: clinicopathological review of 47 cases. Histopathology. 2014;64(7):981–93.CrossRefPubMedPubMedCentral Khoury T, Karabakhtsian RG, Mattson D, et al. Pleomorphic lobular carcinoma in situ of the breast: clinicopathological review of 47 cases. Histopathology. 2014;64(7):981–93.CrossRefPubMedPubMedCentral
Metadata
Title
Does Non-Classic Lobular Carcinoma In Situ at the Lumpectomy Margin Increase Local Recurrence?
Authors
Anna C. Beck, MD
Solange Bayard, MD
George Plitas, MD
Varadan Sevilimedu, MBBS, DrPH
M. Gabriela Kuba, MD
Paula Garcia, MHA
Monica Morrow, MD
Audree B. Tadros, MD, MPH
Publication date
26-07-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-13899-1

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