Management Summary
  • LCIS is an uncommon pathologic finding in the general female population (0.5% to 4.3% of benign breast biopsies), and it is a marker of increased breast cancer risk. Subsequent cancer risk approaches 1% per year and is bilateral.
  • ALH is pathologically similar to LCIS, it but is a risk factor for subsequent breast cancer that is expressed more strongly on the breast ipsilateral to the site of ALH detection.
  • Management strategies of patients with lobular neoplasia must address the increased risk to both breasts. Observation with close surveillance is chosen by most patients; those who develop breast cancer do so at an early stage. Chemoprevention with tamoxifen or raloxifene decreases the risk of invasive cancer significantly in patients with lobular neoplasia. Bilateral prophylactic mastectomy reduces risk by approximately 90%, but should be reserved for those patients at highest risk due to family history and other factors.
  • The presence of LCIS coexistent with an invasive cancer is not a contraindication to breast-conserving therapy, and at this time, it is not necessary to attempt wide local excision for margin control when LCIS is detected at the margins.
  • LCIS is not associated with any mammographic or clinically apparent breast abnormalities; therefore, LCIS detected in a percutaneous core needle biopsy specimen should motivate a search for some other pathologic finding to explain the original biopsy target. This will generally involve open surgical excision to rule out the presence of a coexisting malignancy.