Abstract：
The primary aim of this study was to determine the upgrade rates of variant lobular carcinoma in situ (V-LCIS, ie, combined florid [F-LCIS] and pleomorphic [P-LCIS]) compared with classic LCIS (C-LCIS) when diagnosed on core needle biopsy (CNB). The secondary goal was to determine the rate of progression/development of invasive carcinoma on long-term follow-up after primary excision. After institutional review board approval, our institutional pathology database was searched for patients with \"pure\" LCIS diagnosed on CNB who underwent subsequent excision. Radiologic findings were reviewed, radiologic-pathologic (rad-path) correlation was performed, and follow-up patient outcome data were obtained. One hundred twenty cases of LCIS were identified on CNB (C-LCIS = 97, F-LCIS = 18, and P-LCIS = 5). Overall upgrade rates after excision for C-LCIS, F-LCIS, and P-LCIS were 14% (14/97), 44% (8/18), and 40% (2/5), respectively. Of the total cases, 79 (66%) were deemed rad-path concordant. Of these, the upgrade rate after excision for C-LCIS, F-LCIS, and P-LCIS was 7.5% (5 of 66), 40% (4 of 10), and 0% (0 of 3), respectively. The overall upgrade rate for V-LCIS was higher than for C-LCIS (P = .004), even for the cases deemed rad-path concordant (P value: .036). Most upgraded cases (23 of 24) showed pT1a disease or lower. With an average follow-up of 83 months, invasive carcinoma in the ipsilateral breast was identified in 8/120 (7%) cases. Six patients had died: 2 of (contralateral) breast cancer and 4 of other causes. Because of a high upgrade rate, V-LCIS diagnosed on CNB should always be excised. The upgrade rate for C-LCIS (even when rad-path concordant) is higher than reported in many other studies. Rad-path concordance read, surgical consultation, and individualized decision making are recommended for C-LCIS cases. The risk of developing invasive carcinoma after LCIS diagnosis is small (7% with ∼7-year follow-up), but active surveillance is required to diagnose early-stage disease.
摘要：
本研究的主要目的是确定变异型小叶原位癌的升级率（V-LCIS，即在芯针活检（CNB）上诊断时，与经典LCIS（C-LCIS）相比，结合了花语[F-LCIS]和多形性[P-LCIS]）。次要目标是在初次切除后的长期随访中确定浸润性癌的进展/发展速率。机构审查委员会批准后，在我们的机构病理学数据库中搜索了在CNB上诊断为“纯”LCIS的患者,这些患者接受了随后的切除术.放射学检查结果进行了回顾，进行放射学-病理学（rad-path）相关性，并获得随访患者结果数据。在CNB上确定了120例LCIS（C-LCIS=97，F-LCIS=18，P-LCIS=5）。C-LCIS切除后的整体升级率，F-LCIS,P-LCIS为14%(14/97)，44%（8/18），分别为40%(2/5)。在所有案件中，79(66%)被认为是rad-path一致的。其中,C-LCIS切除后的升级率，F-LCIS,P-LCIS为7.5%(66个中的5个)，40％（10个中的4个），和0%(3个中的0个)。V-LCIS的整体升级率高于C-LCIS（p值：0.004），即使对于被认为是rad路径一致的情况(p值0.036)。大多数升级病例（24个中的23个）显示pT1a疾病或更低。平均随访83个月,在8/120例（7％）中发现了同侧乳腺的浸润性癌。6例患者死亡：2例（对侧）乳腺癌和4例其他原因。由于升级率高，在CNB上诊断的V-LCIS应始终切除。C-LCIS的升级率（即使rad路径一致）高于许多其他研究中的报告。Rad-path一致性读取,外科会诊,建议对C-LCIS病例进行个性化决策。LCIS诊断后发生浸润性癌的风险很小(7%~7年随访)，但是需要积极的监测来诊断早期疾病。
