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Mouabbi JA, Raghavendra AS, Bassett RL, Christgen M, Middleton L, Teshome M, Nasrazadani A, Hortobagyi G, Hassan A, Tripathy D, Layman RM. Absence of lobular carcinoma in situ is a poor prognostic marker in invasive lobular carcinoma. Eur J Cancer 2023; 191:113250. [PMID: 37573674 PMCID: PMC10529602 DOI: 10.1016/j.ejca.2023.113250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023]
Abstract
AIM To determine if the outcomes of patients with ILC co-occurring with LCIS are similar to pure ILC and if the presence of LCIS is a prognostic factor for ILC. METHODS In an observational, population-based investigation using data from the MD Anderson breast cancer prospectively collected electronic database, we analysed patients with a diagnosis of stage I-III ILC. Patients were divided into two groups: those with ILC with co-occurring ipsilateral LCIS (ILC + LCIS) and those with pure ILC without a histologically detected co-occurring ipsilateral LCIS (ILC alone). We obtained data on demographics, pathologic tumour size (pT), pathologic lymph node (pN) involvement, estrogen (ER), progesterone (PR) receptor status, HER2 status, Ki67, treatment received, distant recurrence-free and overall survival (DRFS, OS). RESULTS We identified 4217 patients with stage I-III ILC treated at MD Anderson between 1966 and 2021. 45% of cases (n = 1881) had co-existing LCIS. Statistically and numerically, ILC alone tended to associate with pT4 and pN3 stage (P < 0.001), ER/PR negativity (P = 0.0002), HER2 positivity (P = 0.010), higher Ki67 (P = 0.005), non-classical ILC subtype (P = 0.04) and more exposure to neoadjuvant chemotherapy (P = 0.0002) compared to the ILC + LCIS group. The median follow-up time was 6.5 years. Patients with ILC + LCIS had better median DRFS (16.8 versus 10.1 years, Hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.50-0.60, P < 0.0001) and better median OS (18.9 versus 13.7 years, HR 0.62, 95% CI 0.56-0.69; P < 0.0001). Multivariate analysis showed the absence of LCIS to be an independent poor prognostic factor along with a higher pT stage and higher pN stage for DRFS and OS. CONCLUSION The findings of this study suggests that the absence of ipsilateral LCIS with ILC is an independent poor prognostic factor and that further studies are warranted to understand this phenomenon.
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Affiliation(s)
- Jason A Mouabbi
- Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Akshara Singareeka Raghavendra
- Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roland L Bassett
- Department of Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthias Christgen
- Institute of Pathology, Hannover Medical School, Hannover, Germany; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lavinia Middleton
- Department of Pathology, Unit 0085, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Azadeh Nasrazadani
- Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriel Hortobagyi
- Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Hassan
- Department of Pathology, Unit 0085, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debasish Tripathy
- Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rachel M Layman
- Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Unit 462, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lunt L, Coogan A, Perez CB. Lobular Neoplasia. Surg Clin North Am 2022; 102:947-963. [DOI: 10.1016/j.suc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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3
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Harris CG, Eslick GD. Impact of lobular carcinoma in situ on local recurrence in breast cancer treated with breast conservation therapy: a systematic review and meta-analysis. ANZ J Surg 2021; 91:1696-1703. [PMID: 33634956 DOI: 10.1111/ans.16671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lobular carcinoma in situ (LCIS) is a known risk factor for breast cancer of unclear significance when detected in association with invasive carcinoma. This meta-analysis aims to determine the impact of LCIS on local recurrence risk for individuals with breast cancer treated with breast conservation therapy to help guide appropriate management strategies. METHODS We identified relevant studies from five electronic databases. Studies were deemed suitable for inclusion where they compared patients with invasive breast cancer and concurrent LCIS to those with breast cancer alone, all patients underwent breast conservation therapy (lumpectomy with adjuvant radiation therapy) and local recurrence was evaluated. Recurrence data were pooled by use of a random-effects model. RESULTS From 1488 citations screened by our search, nine studies were deemed suitable for inclusion. These studies comprised 990 cases and 12 870 controls. Median follow-up time was 104 months. There was a significantly increased risk of overall local recurrence of breast cancer for individuals with LCIS in association with breast cancer following breast conservation therapy (pooled odds ratio (pOR) 1.73; 95% confidence interval (CI) 1.10-2.71; P = 0.018). The risk of local recurrence was not significantly increased at 5 years (pOR 1.00; 95% CI 0.49-2.04; P = 0.995) and 10 years (pOR 1.52; 95% CI 0.72-3.23; P = 0.275). CONCLUSION Individuals with LCIS in association with invasive breast cancer have an increased risk of local recurrence following breast conservation therapy. This supports consideration of increased medical surveillance and exploration of further risk reduction strategies for such patients.
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Affiliation(s)
- Christopher G Harris
- Department of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Guy D Eslick
- Department of Surgery, The University of Sydney, Sydney, New South Wales, Australia
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4
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Minami CA, Zabor EC, Gilbert E, Newman A, Park A, Jochelson MS, King TA, Pilewskie ML. Do Body Mass Index and Breast Density Impact Cancer Risk Among Women with Lobular Carcinoma In Situ? Ann Surg Oncol 2020; 27:1844-1851. [PMID: 31898097 DOI: 10.1245/s10434-019-08126-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Both body mass index (BMI) and breast density impact breast cancer risk in the general population. Whether obesity and density represent additive risk factors in women with lobular carcinoma in situ (LCIS) is unknown. METHODS Patients diagnosed with LCIS from 1988 to 2017 were identified from a prospectively maintained database. BMI was categorized by World Health Organization classification. Density was captured as the mammographic Breast Imaging Reporting and Data System (BIRADS) value. Other covariates included age at LCIS diagnosis, menopausal status, family history, chemoprevention, and prophylactic mastectomy. Cancer-free probability was estimated using the Kaplan-Meier method, and Cox regression models were used for univariable and multivariable analyses. RESULTS A total of 1222 women with LCIS were identified. At a median follow-up of 7 years, 179 women developed breast cancer (121 invasive, 58 ductal carcinoma in situ); 5- and 10-year cumulative incidences of breast cancer were 10% and 17%, respectively. In multivariable analysis, increased breast density (BIRADS C/D vs. A/B) was significantly associated with increased hazard of breast cancer (hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.52-3.88), whereas BMI was not. On multivariable analysis, chemoprevention use was associated with a significantly decreased hazard of breast cancer (HR 0.49, 95% CI 0.29-0.84). Exploratory analyses did not demonstrate significant interaction between BMI and menopausal status, BMI and breast density, BMI and chemoprevention use, or breast density and chemoprevention. CONCLUSIONS Breast cancer risk among women with LCIS is impacted by breast density. These results aid in personalizing risk assessment among women with LCIS and highlight the importance of chemoprevention counseling for risk reduction.
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Affiliation(s)
- Christina A Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ashley Newman
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna Park
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Melissa L Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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6
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Roche CA, Tang R, Coopey SB, Hughes KS. Chemoprevention acceptance and adherence in women with high-risk breast lesions. Breast J 2018; 25:190-195. [DOI: 10.1111/tbj.13064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Constance A Roche
- Division of Surgical Oncology; Massachusetts General Hospital; Boston MA USA
| | - Rong Tang
- Division of Surgical Oncology; Massachusetts General Hospital; Boston MA USA
| | - Suzanne B Coopey
- Division of Surgical Oncology; Massachusetts General Hospital; Boston MA USA
| | - Kevin S Hughes
- Division of Surgical Oncology; Massachusetts General Hospital; Boston MA USA
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Qin JH, Wang L, Li QL, Liang Y, Ke ZY, Wang RA. Epithelial-mesenchymal transition as strategic microenvironment mimicry for cancer cell survival and immune escape? Genes Dis 2016; 4:16-18. [PMID: 30258903 PMCID: PMC6136597 DOI: 10.1016/j.gendis.2016.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/10/2016] [Indexed: 12/19/2022] Open
Abstract
Epithelial-mesenchymal transition (EMT) is the phenotypic transition of epithelial cells to mesenchymal cells characterized by loss of epithelial markers, loss of intercellular adherence and acquirement of mesenchymal cell markers and increased locomotive ability. EMT is widely considered to be a gene regulated process necessary for cancer metastasis. Yet it is a highly controversial issue. We here propose that EMT is an environmentally induced cell behavior. It is the mimicry of their living environment. It is a survival strategy, a way of immune escape. We also propose here that the epithelial cell markers may functionally act as tumor antigens since in the mesenchymal surroundings there are no other structures bearing the same antigens as epithelial cells.
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Affiliation(s)
- Jun-Hui Qin
- State Key Laboratory of Cancer Biology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.,Department of Pathology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Li Wang
- State Key Laboratory of Cancer Biology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.,Department of Pathology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Qin-Long Li
- State Key Laboratory of Cancer Biology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.,Department of Pathology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Yuan Liang
- State Key Laboratory of Cancer Biology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.,Department of Pathology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Zhen-Yu Ke
- State Key Laboratory of Cancer Biology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.,Department of Pathology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Rui-An Wang
- State Key Laboratory of Cancer Biology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.,Department of Pathology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
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8
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Begg CB, Ostrovnaya I, Carniello JVS, Sakr RA, Giri D, Towers R, Schizas M, De Brot M, Andrade VP, Mauguen A, Seshan VE, King TA. Clonal relationships between lobular carcinoma in situ and other breast malignancies. Breast Cancer Res 2016; 18:66. [PMID: 27334989 PMCID: PMC4918003 DOI: 10.1186/s13058-016-0727-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 06/05/2016] [Indexed: 11/29/2022] Open
Abstract
Background Recent evidence suggests that lobular carcinoma in situ (LCIS) can be a clonal precursor of invasive breast cancers of both the ductal and lobular phenotypes. We sought to confirm these findings with an extensive study of fresh frozen breast specimens from women undergoing mastectomy. Methods Patients with a history of LCIS presenting for therapeutic mastectomy were identified prospectively. Frozen tissue blocks were collected, screened for lesions of interest, and subjected to microdissection and DNA extraction. Copy number profiling, whole-exome sequencing, or both were performed. Clonal relatedness was assessed using specialized statistical techniques developed for this purpose. Results After exclusions for genotyping failure, a total of 84 lesions from 30 patients were evaluated successfully. Strong evidence of clonal relatedness was observed between an LCIS lesion and the invasive cancer for the preponderance of cases with lobular carcinoma. Anatomically distinct in situ lesions of both ductal and lobular histology were also shown to be frequently clonally related. Conclusions These data derived from women with LCIS with or without invasive cancer confirm that LCIS is commonly the clonal precursor of invasive lobular carcinoma and that distinct foci of LCIS frequently share a clonal origin, as do foci of LCIS and ductal carcinoma in situ. Electronic supplementary material The online version of this article (doi:10.1186/s13058-016-0727-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colin B Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jose V Scarpa Carniello
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Rita A Sakr
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Dilip Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Russell Towers
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Michail Schizas
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Marina De Brot
- Department of Pathology, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Victor P Andrade
- Department of Pathology, AC Camargo Cancer Center, Rua Professor Antônio Prudente, 211, Liberdade, São Paulo, SP, CEP 01509 - 010, Sao Paulo, Brazil
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Venkatraman E Seshan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Tari A King
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Clauser P, Marino MA, Baltzer PAT, Bazzocchi M, Zuiani C. Management of atypical lobular hyperplasia, atypical ductal hyperplasia, and lobular carcinoma in situ. Expert Rev Anticancer Ther 2016; 16:335-46. [PMID: 26780850 DOI: 10.1586/14737140.2016.1143362] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atypical hyperplasia and lobular carcinoma in situ are rare proliferative breast lesions, growing inside ducts and terminal ducto-lobular units. They represent a marker of increased risk for breast cancer and a non-obligate precursor of malignancy. Evidence available on diagnosis and management is scarce. They are frequently found incidentally associated with other lesions, but can be visible through mammography, ultrasound or magnetic resonance. Due to the risk of underestimation, surgical excision is often performed. The analysis of imaging and histopathological characteristics could help identifying low-risk cases, for which surgery is not necessary. Chemopreventive agents can be used for risk reduction. Careful imaging follow up is mandatory; the role of breast MRI as screening modality is under discussion.
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Affiliation(s)
- Paola Clauser
- a Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging , Medical University of Vienna , Vienna , Austria
| | - Maria A Marino
- a Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging , Medical University of Vienna , Vienna , Austria
| | - Pascal A T Baltzer
- a Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging , Medical University of Vienna , Vienna , Austria
| | - Massimo Bazzocchi
- b Institute of Diagnostic Radiology , Department of Medical and Biological Sciences, University of Udine , Udine , Italy
| | - Chiara Zuiani
- b Institute of Diagnostic Radiology , Department of Medical and Biological Sciences, University of Udine , Udine , Italy
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Personalized Screening for Breast Cancer: A Wolf in Sheep's Clothing? AJR Am J Roentgenol 2015; 205:1365-71. [DOI: 10.2214/ajr.15.15293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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11
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Purushothaman HN, Lekanidi K, Shousha S, Wilson R. Lesions of uncertain malignant potential in the breast (B3): what do we know? Clin Radiol 2015; 71:134-40. [PMID: 26607917 DOI: 10.1016/j.crad.2015.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/10/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
Abstract
Breast lesions classified as of uncertain malignant potential (B3) on biopsy form a diverse group of abnormalities, which pose a diagnostic and management challenge. In this paper, we discuss the imaging and pathology features as well as the management of the most controversial B3 lesions, consisting of papillary lesions, complex sclerosing lesions/radial scars, lobular intraepithelial neoplasia, and atypical epithelial proliferation of ductal type. As there is an association with malignancy at the time of diagnosis, as well as an increase in the risk of subsequent development of cancer, a multidisciplinary discussion is almost always required to tailor treatment.
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Affiliation(s)
- H N Purushothaman
- Breast Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| | - K Lekanidi
- Park Centre for Breast Care, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road, Brighton BN1 6AG, UK.
| | - S Shousha
- Breast Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| | - R Wilson
- Breast Unit, The Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK
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12
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King TA, Pilewskie M, Muhsen S, Patil S, Mautner SK, Park A, Oskar S, Guerini-Rocco E, Boafo C, Gooch JC, De Brot M, Reis-Filho JS, Morrogh M, Andrade VP, Sakr RA, Morrow M. Lobular Carcinoma in Situ: A 29-Year Longitudinal Experience Evaluating Clinicopathologic Features and Breast Cancer Risk. J Clin Oncol 2015; 33:3945-52. [PMID: 26371145 DOI: 10.1200/jco.2015.61.4743] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The increased breast cancer risk conferred by a diagnosis of lobular carcinoma in situ (LCIS) is poorly understood. Here, we review our 29-year longitudinal experience with LCIS to evaluate factors associated with breast cancer risk. PATIENTS AND METHODS Patients participating in surveillance after an LCIS diagnosis are observed in a prospectively maintained database. Comparisons were made among women choosing surveillance, with or without chemoprevention, and those undergoing bilateral prophylactic mastectomies between 1980 and 2009. RESULTS One thousand sixty patients with LCIS without concurrent breast cancer were identified. Median age at LCIS diagnosis was 50 years (range, 27 to 83 years). Fifty-six patients (5%) underwent bilateral prophylactic mastectomy; 1,004 chose surveillance with (n = 173) or without (n = 831) chemoprevention. At a median follow-up of 81 months (range, 6 to 368 months), 150 patients developed 168 breast cancers (63% ipsilateral, 25% contralateral, 12% bilateral), with no dominant histology (ductal carcinoma in situ, 35%; infiltrating ductal carcinoma, 29%; infiltrating lobular carcinoma, 27%; other, 9%). Breast cancer incidence was significantly reduced in women taking chemoprevention (10-year cumulative risk: 7% with chemoprevention; 21% with no chemoprevention; P < .001). In multivariable analysis, chemoprevention was the only clinical factor associated with breast cancer risk (hazard ratio, 0.27; 95% CI, 0.15 to 0.50). In a subgroup nested case-control analysis, volume of disease, which was defined as the ratio of slides with LCIS to total number of slides reviewed, was also associated with breast cancer development (P = .008). CONCLUSION We observed a 2% annual incidence of breast cancer among women with LCIS. Common clinical factors used for risk prediction, including age and family history, were not associated with breast cancer risk. The lower breast cancer incidence in women opting for chemoprevention highlights the potential for risk reduction in this population.
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Affiliation(s)
- Tari A King
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY.
| | | | - Shirin Muhsen
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sujata Patil
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
| | - Starr K Mautner
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anna Park
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sabine Oskar
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Camilla Boafo
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica C Gooch
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marina De Brot
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mary Morrogh
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
| | - Victor P Andrade
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rita A Sakr
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica Morrow
- All authors: Memorial Sloan Kettering Cancer Center, New York, NY
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Abstract
Gene mutation's role in initiating carcinogenesis has been controversial, but it is consensually accepted that both carcinogenesis and cancer metastasis are gene-regulated processes. MTA1, a metastasis-associated protein, has been extensively researched, especially regarding its role in cancer metastasis. In this review, I try to elucidate MTA1's role in both carcinogenesis and metastasis from a different angle. I propose that MTA1 is a stress response protein that is upregulated in various stress-related situations such as heat shock, hypoxia, and ironic radiation. Cancer cells are mostly living in a stressful environment of hypoxia, lack of nutrition, and immune reaction attacks. To cope with all these stresses, MTA1 expression is upregulated, plays a role of master regulator of gene expression, and helps cancer cells to survive and migrate out of their original dwelling.
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Affiliation(s)
- Rui-An Wang
- State Key Lab for Cancer Biology, Department of Pathology, Xijing Hospital, Xi'an, China,
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14
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Outcomes of patients with lobular in situ neoplasia of the breast: The role of vacuum-assisted biopsy. Breast 2014; 23:651-5. [DOI: 10.1016/j.breast.2014.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/17/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022] Open
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15
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Synchronous lobular carcinoma in situ and invasive lobular cancer: Marker or precursor for invasive lobular carcinoma. Eur J Surg Oncol 2014; 40:1245-9. [DOI: 10.1016/j.ejso.2014.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/01/2014] [Accepted: 04/11/2014] [Indexed: 11/16/2022] Open
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Vlug E, Ercan C, van der Wall E, van Diest PJ, Derksen PWB. Lobular Breast Cancer: Pathology, Biology, and Options for Clinical Intervention. Arch Immunol Ther Exp (Warsz) 2013; 62:7-21. [DOI: 10.1007/s00005-013-0251-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 08/05/2013] [Indexed: 12/13/2022]
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17
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Wang RA, Li ZS, Zhang HZ, Zheng PJ, Li QL, Shi JG, Yan QG, Ye J, Wang JB, Guo Y, Huang XF, Yu YH. Invasive cancers are not necessarily from preformed in situ tumours - an alternative way of carcinogenesis from misplaced stem cells. J Cell Mol Med 2013; 17:921-6. [PMID: 23741988 PMCID: PMC3822897 DOI: 10.1111/jcmm.12078] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 03/29/2013] [Indexed: 11/28/2022] Open
Abstract
Cancers are thought to be the result of accumulated gene mutations in cells. Carcinomas, which are cancers arising from epithelial tissues usually go through several stages of development: atypical hyperplasia, carcinoma in situ and then invasive carcinoma, which might further metastasize. However, we think that the present pathological data are enough to prove that there might be an alternative way of carcinogenesis. We propose that majority of invasive cancers arise in the connective tissue stroma de novo, from the misplaced epithelial stem cells which come to the wrong land of connective tissue stroma by accident. The in situ carcinomas, which are mostly curable, should not be considered genuine cancer, but rather as quasi-cancer. We design this new theory of carcinogenesis as the stem cell misplacement theory (SCMT). Our SCMT theory chains together other carcinogenesis theories such as the inflammation-cancer chain, the stem cell theory and the tissue organization field theory. However, we deny the pathway of somatic mutation theory as the major pathway of carcinogenesis.
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Affiliation(s)
- Rui-An Wang
- State Key Lab of Cancer Biology, The Fourth Military Medical University, Xi'an, Shaanxi Pr., China.
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18
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Cole K, Tabernero M, Anderson KS. Biologic characteristics of premalignant breast disease. Cancer Biomark 2012; 9:177-92. [PMID: 22112476 DOI: 10.3233/cbm-2011-0187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Breast cancer is the second leading cause of cancer death in women in the United States. While mammography and breast magnetic resonance imaging (MRI) improve detection of early disease, there remains an unmet need for biomarkers for risk stratification, early detection, prediction, and disease prognosis. A number of early breast lesions, from atypical hyperplasias to carcinomas in situ, are associated with an increased risk of developing subsequent invasive breast carcinoma. The recent development of genomic, epigenomic, and proteomic tools for tissue biomarker detection, including array CGH, RNA expression microarrays, and proteomic arrays have identified a number of potential biomarkers that both identify patients at increased risk, as well as provided insights into the pathology of early breast cancer development. This chapter focuses on the detection and application of tissue and serum biomarkers for the identification and risk stratification of early breast cancer lesions.
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Affiliation(s)
- Kimberly Cole
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, USA
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19
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Murray L, Reintgen M, Akman K, Cox C, Cox J, Reintgen D, Greenberg H, Vrcel V. Pleomorphic lobular carcinoma in situ: treatment options for a new pathologic entity. Clin Breast Cancer 2011; 12:76-9. [PMID: 22037287 DOI: 10.1016/j.clbc.2011.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 08/18/2011] [Accepted: 08/26/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Lauren Murray
- University of South Florida/Florida Hospital - Tampa Breast Care Center, Tampa, FL 33612, USA
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20
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Feig S. Comparison of costs and benefits of breast cancer screening with mammography, ultrasonography, and MRI. Obstet Gynecol Clin North Am 2011; 38:179-96, ix. [PMID: 21419333 DOI: 10.1016/j.ogc.2011.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Screening mammography performed annually on all women beginning at age 40 years has reduced breast cancer deaths by 30% to 50%. The cost per year of life saved is well within the range for other commonly accepted medical interventions. Various studies have estimated that reduction in treatment costs through early screening detection may be 30% to 100% or more of the cost of screening. Magnetic resonance imaging (MRI) screening is also cost-effective for very high-risk women, such as BRCA carriers, and others at 20% or greater lifetime risk. Further studies are needed to determine whether MRI is cost-effective for those at moderately high (15%-20%) lifetime risk. Future technical advances could make MRI more cost-effective than it is today. Automated whole-breast ultrasonography will probably prove cost-effective as a supplement to mammography for women with dense breasts.
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Affiliation(s)
- Stephen Feig
- Department of Radiological Sciences, UC Irvine Medical Center, Orange, CA 92868, USA.
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21
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Hussain M, Cunnick GH. Management of lobular carcinoma in-situ and atypical lobular hyperplasia of the breast--a review. Eur J Surg Oncol 2011; 37:279-89. [PMID: 21306860 DOI: 10.1016/j.ejso.2011.01.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 12/29/2010] [Accepted: 01/06/2011] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To determine the incidence of malignancy (invasive carcinoma or DCIS) in patients diagnosed with lobular neoplasia (B3) on core needle biopsy (CNB) of breast lesions by reviewing the published literature. METHODS Medline, Embase, OVID-database and reference lists were searched to identify and review all English-language articles addressing the management of LN diagnosed on CNB. Studies on mixed breast pathologies were excluded. RESULTS Of 1229 LN diagnosed on CNB, 789 (64%) underwent surgical excision. 211 (27%) of excisions contained either DCIS or invasive disease. 280 of the excision specimens were classified as ALH, 241 as LCIS, 22 as pleomorphic LCIS and 246 unspecified LN on the original CNB. After surgical excision, 19% of the ALH cases, 32% of the LCIS cases and 41% of the PLCIS cases, contained malignancy. 29% of the unspecified LNs were upgraded to malignancy. The higher incidence of malignancy within excision specimens for LCIS and PLCIS compared to ALH was significant (P < 0.04, <0.003 respectively). CONCLUSION There is a significant underestimation of malignancy in patients diagnosed with breast LN on CNB. 27% cases of CNB-diagnosed LN were found to contain malignancy following surgical excision. All patients diagnosed with LN on CNB should be considered for surgical excision biopsy.
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Affiliation(s)
- M Hussain
- Wycombe General Hospital, Department of Breast Surgery, Queen Alexandra Road, High Wycombe, Buckinghamshire HP11 2TT, UK
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22
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Zhang X, Hanamura N, Yamasita M, Kashikura Y, Ogawa T, Taizo S. A case of lobular carcinoma in situ presenting as a solid mass. Br J Radiol 2011; 84:e48-50. [PMID: 21325356 DOI: 10.1259/bjr/32795948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A patient presented with a 2 cm lump in the lower outer quadrant of the left breast. Mammogram and ultrasonography showed a solid mass with a microlobulated contour, partially irregular border and microcalcifications. MRI showed an irregular mass with early enhancement and high signal intensity, and the late-phase image demonstrated a partial washout pattern. These findings suggest that the tumour was a malignant invasive carcinoma. Non-invasive ductal carcinoma was diagnosed after a fine needle aspiration and core needle biopsy followed by a partial breast excision and sentinel lymph node (SLN) biopsy. A pathological examination of the lesion displayed characteristic small monomorphic cells, solid proliferation and massive distension within the lobular unit. The tumour was immunohistochemically negative for E-cadherin and pure lobular carcinoma in situ (LCIS) was diagnosed. Pure LCIS is very rare and there have been no previous reports of pure LCIS forming a solid mass.
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Affiliation(s)
- X Zhang
- Department of Breast Surgery and, Mie University Hospital, Japan.
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23
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Choi BB, Kim SH, Park CS, Cha ES, Lee AW. Radiologic findings of lobular carcinoma in situ: mammography and ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:59-63. [PMID: 21213330 DOI: 10.1002/jcu.20772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 10/05/2010] [Indexed: 05/30/2023]
Abstract
PURPOSE The purpose was to evaluate the mammographic and sonographic (US) features of lobular carcinoma in situ (LCIS). Methods. Mammographic and US findings of nine lesions diagnosed pathologically as pure LCIS were analyzed retrospectively according to the American College of Radiology breast imaging reporting and data system (BI-RADS) lexicon. RESULTS With regards to mammographic findings of LCIS, there were no lesions demonstrated in six cases and a mass in three cases, two of which contained microcalcifications. The most common US findings of LCIS were irregular shape (five cases), ill-defined margins (eight cases), and hypoechogenicity (seven cases). All cases had an elongated shape parallel to the skin or were round (no lesion had a taller-than-wide shape). Two cases were associated with microcalcifications. The final BI-RADS categories were category 3 (probably benign finding) in one case, category 4A (low suspicion of malignancy) in two cases, and category 4B (intermediate suspicion of malignancy) in six cases. CONCLUSIONS LCIS is frequently mammographically occult, and an incidental finding on routine screening mammograms, usually because of microcalcifications. LCIS, a high-risk lesion, can mimic invasive carcinoma on US.
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Affiliation(s)
- Bo Bae Choi
- Department of Radiology, Chungnam University Hospital, Jung- gu, Deajeon, Korea
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24
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Feig S. Cost-Effectiveness of Mammography, MRI, and Ultrasonography for Breast Cancer Screening. Radiol Clin North Am 2010; 48:879-91. [DOI: 10.1016/j.rcl.2010.06.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Lobular neoplasia displaying central necrosis: a potential diagnostic pitfall. Pathol Res Pract 2010; 206:544-9. [PMID: 20359832 DOI: 10.1016/j.prp.2010.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 02/08/2010] [Accepted: 02/24/2010] [Indexed: 11/16/2022]
Abstract
The distinction between intraepithelial proliferations of ductal and lobular type is often straightforward. However, a small number of cases create diagnostic problems even for experienced pathologists. Among those is the recognized, but not always kept in mind, lobular neoplasia with "comedo-type" necrosis. Herein, we present six cases of lobular neoplasia with comedo necrosis. Three cases were classified correctly, whereas the three remaining cases were initially misdiagnosed as ductal carcinoma in situ with necrosis. Of these three misdiagnosed cases, one patient underwent radiation therapy before this study was carried out. The two other patients were correctly reclassified as lobular type in subsequent excisional biopsies. One case showed a focus of microinvasion. All six lesions were negative by E-cadherin immunohistochemistry. Our experience highlights that the correct differentiation between intraepithelial neoplasias of ductal and lobular type may be challenging, and that the correct differentiation is extremely important for prognostic information and therapeutic decisions.
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Green AR, Young P, Krivinskas S, Rakha EA, Claire Paish E, Powe DG, Ellis IO. The expression of ERalpha, ERbeta and PR in lobular carcinoma in situ of the breast determined using laser microdissection and real-time PCR. Histopathology 2009; 54:419-27. [PMID: 19309393 DOI: 10.1111/j.1365-2559.2009.03233.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To determine the status of oestrogen receptor (ER) subtypes (ERalpha and ERbeta) in lobular carcinoma in situ (LCIS) of the breast. METHODS AND RESULTS Forty-seven cases of LCIS and six cases with normal breast lobules were subjected to immunohistochemistry and evaluated for ERalpha, ERbeta and progesterone receptor (PR) expression. mRNA for ERalpha, ERbeta1 and ERbeta2 were quantified in LCIS and normal lobules using laser microdissection coupled with real-time polymerase chain reaction. LCIS showed a higher level of steroid receptor protein expression than normal lobules. There was no difference in ERbeta1 gene or ERbeta protein expression between normal lobules, pure LCIS, or LCIS associated with invasive breast cancer. No significant difference in expression of either ERalpha or ERbeta was found between pure LCIS and LCIS associated with invasive cancer. However, PR was significantly lower in those cases of LCIS with associated invasive than in those without synchronous invasive disease. CONCLUSIONS Increased expression of steroid receptors in LCIS suggests their possible role in the biology of LCIS and, for PR, could influence the predisposition of women diagnosed with LCIS to develop invasive breast carcinoma.
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Affiliation(s)
- Andrew R Green
- Division of Pathology, School of Molecular Medical Sciences, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.
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28
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Beyond Standard Mammographic Screening: Mammography at Age Extremes, Ultrasound, and MR Imaging. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.cult.2009.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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29
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Londero V, Zuiani C, Linda A, Vianello E, Furlan A, Bazzocchi M. Lobular neoplasia: Core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features. Breast 2008; 17:623-30. [DOI: 10.1016/j.breast.2008.05.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 05/14/2008] [Accepted: 05/15/2008] [Indexed: 11/24/2022] Open
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31
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What is the sensitivity of mammography and dynamic MR imaging for DCIS if the whole-breast histopathology is used as a reference standard? LA RADIOLOGIA MEDICA 2008; 113:439-51. [DOI: 10.1007/s11547-008-0250-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 06/22/2007] [Indexed: 10/22/2022]
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32
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Nagi CS, O'Donnell JE, Tismenetsky M, Bleiweiss IJ, Jaffer SM. Lobular neoplasia on core needle biopsy does not require excision. Cancer 2008; 112:2152-8. [DOI: 10.1002/cncr.23415] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Loss of expression of chromosome 16q genes DPEP1 and CTCF in lobular carcinoma in situ of the breast. Breast Cancer Res Treat 2008; 113:59-66. [PMID: 18213475 DOI: 10.1007/s10549-008-9905-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2007] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Loss of the chromosomal material at 16q is the most frequent genetic event in invasive and in situ (LCIS) lobular carcinoma of the breast. However, the smallest region of overlap at 16q is not restricted to just the CDH1 locus harbouring E-cadherin, suggesting that neighbouring genes might be involved in the development and progression of these tumours. Potential novel tumour suppressor genes (TSG) at 16q include CCCTC-binding factor (CTCF), Decreased Expression in Renal and Prostate Cancer (DERPC) and Dipeptidase 1 (DPEP1). The aim of this study is to assess the expression of these genes in LCIS and compare them with normal breast, using CDH1 as a control, in order to evaluate their role as TSGs. METHODS Cells from LCIS cases and normal breast lobules were microdissected and expression of target genes were quantified using real-time PCR. In addition, immunohistochemistry (IHC) for E-cadherin and CTCF was performed on paraffin processed LCIS (n=49) and normal breast cases. RESULTS All LCIS showed negative expression of E-cadherin. Similar to CDH1, CTCF and DPEP1 gene expression was significantly lower in LCIS cases compared with normal cases (P<0.05). CTCF IHC expression showed significant reduction in LCIS compared to normal parenchymal cells. However, there was no difference in expression of DERPC between LCIS and normal breast tissue. CONCLUSIONS In addition to CDH1, loss of CTCF and DPEP1 gene expression suggest they are possible TSG in breast cancer and may, similar to CDH1, be potentially utilised as markers of predisposition of women diagnosed with LCIS.
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Berg WA. Beyond standard mammographic screening: mammography at age extremes, ultrasound, and MR imaging. Radiol Clin North Am 2007; 45:895-906, vii. [PMID: 17888776 DOI: 10.1016/j.rcl.2007.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article describes the principles and performance of screening mammography and discusses indications for screening before the age of 40 years and after the age of 69 years. Specific definitions of high risk are provided, and the rationale and performance characteristics to dare of supplemental screening with ultrasound or MR imaging are reviewed.
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Affiliation(s)
- Wendie A Berg
- American Radiology Services, Johns Hopkins Green Spring, 301 Merrie Hunt Dr., Lutherville, MD 21093, USA.
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35
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Nonni A, Zagouri F, Sergentanis TN, Lazaris AC, Patsouris ES, Zografos GC. Immunohistochemical expression of estrogen receptors alpha and beta in lobular neoplasia. Virchows Arch 2007; 451:893-7. [PMID: 17924141 DOI: 10.1007/s00428-007-0504-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 08/04/2007] [Accepted: 08/19/2007] [Indexed: 11/28/2022]
Abstract
The designation lobular neoplasia (LN) of the breast includes atypical lobular hyperplasia and lobular carcinoma in situ. Estrogen receptors (ER) play a significant role in breast carcinogenesis. In the present study, ER-alpha and ER-beta status are evaluated in 30 breast tissue specimens from patients whose main lesion was LN. A standard immunohistochemical procedure, using monoclonal antibodies for ER-alpha and ER-beta, was applied to the lesion and the adjacent normal breast tissues, the latter serving as control. In all cases, both receptors were expressed in LN as well as in normal breast ducts and lobules. Concerning ER-alpha, the Allred score and the percentage of ER-alpha-positive cells were significantly higher in LN than in the adjacent normal breast tissue. On the contrary, regarding ER-beta, the Allred score and the percentage of ER-beta-positive cells were significantly lower in LN compared with normal adjacent breast tissue. Greater increase in the percentage of ER-alpha-positive cells was associated with a smaller reduction in the percentage of ER-beta-positive cells and vice versa (Spearman's rho = -0.5044, p = 0.001). In conclusion, upregulation of ER-alpha and downregulation of ER-beta may represent two discrete molecular events in LN pathogenesis. Of notice, a mutually limiting interaction may exist between the two events.
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Affiliation(s)
- Aphrodite Nonni
- 1st Department of Pathology, Medical School, University of Athens, Athens, Greece
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Bowman K, Munoz A, Mahvi DM, Breslin TM. Lobular neoplasia diagnosed at core biopsy does not mandate surgical excision. J Surg Res 2007; 142:275-80. [PMID: 17662303 DOI: 10.1016/j.jss.2007.03.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/13/2007] [Accepted: 03/14/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lobular intraepithelial neoplasia (LIN) is associated with an increased risk of breast malignancy. The significance of LIN diagnosed at core needle biopsy (CNB) is unclear, although many groups recommend surgical excision to rule out lesions, which would require immediate, definitive therapy. Current management options include clinical/mammographic observation and surgical excision. The necessity of routine surgical excision remains controversial due to conflicting opinions on the biological behavior of lobular lesions, diagnostic confusion regarding histopathology, and uncertainty of their association with high-risk lesions. The purpose of this report was to review the published data regarding the incidence of high-risk lesions associated with LIN diagnosed at CNB to clarify the indications for surgical excision. MATERIALS AND METHODS A PubMed search was performed to identify all published articles in English addressing management of LIN diagnosed at CNB. RESULTS The 19 studies that form the basis of this report included a total of 504 subjects. Although the studies differed greatly in their content and methods, they were analyzed as a group for the presence of criteria deemed by the authors to be the most important information to include in a study regarding this issue and thus a reasonably good indicator of the quality of the literature. All of the studies were retrospective, nearly half were nonconsecutive series, and no study reported clear inclusion criteria for surgical excision versus observation. Limitations of the reviewed studies included their retrospective nature, small number of subjects, inconsistent inclusion criteria, and selection bias regarding surgical excision. CONCLUSIONS Based on the reviewed literature, it is difficult to reach a firm evidence-based conclusion regarding optimal management of LIN diagnosed at CNB. Associated high-risk lesions increase the risk of upgrade, but there are no mammographic predictors. The available retrospective literature suggests that some cases of LIN are associated with higher-risk lesions identified on surgical excision but does not support routine excision for all patients.
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Affiliation(s)
- Krista Bowman
- Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792-7375, USA
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Abstract
Breast cancer treatment outcomes have improved as a result of early detection and multidisciplinary treatment approaches. Treatment options continue to expand as understanding increases regarding the relationship between disease burden, biology, and outcome. In this article we present the current principles and challenges that face the clinician who is treating breast disease. Better understanding of the biology of high-risk lesions and the significance of minimal metastatic disease permits better treatment. Advances in reconstructive surgery, continued refinement of resection techniques, and the management of less common presentations of breast cancer are presented.
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MESH Headings
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Humans
- Male
- Mastectomy/methods
- Mastectomy, Segmental
- Patient Selection
- Pregnancy
- Pregnancy Complications, Neoplastic/pathology
- Pregnancy Complications, Neoplastic/surgery
- Sentinel Lymph Node Biopsy
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Affiliation(s)
- Bianca Vazquez
- Department of Surgery, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
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Lavoué V, Graesslin O, Classe JM, Fondrinier E, Angibeau H, Levêque J. Management of lobular neoplasia diagnosed by core needle biopsy: study of 52 biopsies with follow-up surgical excision. Breast 2007; 16:533-9. [PMID: 17629481 DOI: 10.1016/j.breast.2007.04.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 04/16/2007] [Accepted: 04/20/2007] [Indexed: 10/23/2022] Open
Abstract
Lobular neoplasia (LN) is a risk factor for bilateral breast cancer without consensus as to its appropriate management. The authors report on a retrospective multi-institutional study concerning 52 patients in whom a diagnosis of LN was made after core needle biopsy (CNB) and who subsequently underwent surgical excision. The excision specimens revealed seven cases of invasive carcinoma and three cases of ductal carcinoma in situ, indicating an underestimation of lesions at CNB in 19% of cases, and in particular in those patients with pleomorphic LN, and when clinical, radiological masses were detected. This lesion is increasingly being diagnosed by CNB due to widespread screening. Follow-up surgical excision should be performed in order to examine the whole lesion in the case of masses or when the histologic specimen reveals a pleomorphic subtype. In other cases, annual mammographic surveillance should be undertaken due to the persistent long-term risk of developing bilateral breast cancer.
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MESH Headings
- Adult
- Aged
- Biopsy, Needle/statistics & numerical data
- Breast Neoplasms/epidemiology
- Breast Neoplasms/etiology
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/etiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/etiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/etiology
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- France/epidemiology
- Humans
- Middle Aged
- Retrospective Studies
- Risk Factors
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Affiliation(s)
- Vincent Lavoué
- Department of Obstetric Gynecology, CHU Tenon, 4 rue de la Chine 75020 Paris, France
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39
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Abstract
The term lobular neoplasia (LN) includes lobular carcinoma in situ (LCIS) and atypical lobular neoplasia (ALH). It is generally considered to be a risk lesion and a non-obligatory precursor for the subsequent development of an invasive carcinoma in the ipsilateral or contralateral breast. LN has also been termed lobular intraepithelial neoplasia (LIN). A grading system (LIN 1-LIN 3) has been suggested as a tool for a more precise estimation of the individual risk. When LN is the most significant finding in a core biopsy, the probability of a higher grade lesion is about 17% in the follow-up surgical biopsy, justifying follow-up surgery in the majority of cases. A higher risk of progression is attributed to LIN 3 (pleomorphic LN, extensive LN, and signet ring cell LN) compared to LIN 1 or LIN 2. These special forms of LN may have an unusual presentation clinically or histologically. Using immunohistology, LN are characterized by the loss of E-cadherin, low proliferative activity and by positive hormone receptor status. The molecular characteristics of LN are similar to those of invasive lobular carcinomas, indicating the nature of LN as a precursor lesion.
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Affiliation(s)
- H P Sinn
- Pathologisches Institut, Universitätsklinikum, Im Neuenheimer Feld 220, 69120, Heidelberg, Germany.
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40
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Rintala-Maki ND, Goard CA, Langdon CE, Wall VE, Traulsen KEA, Morin CD, Bonin M, Sutherland LC. Expression of RBM5-related factors in primary breast tissue. J Cell Biochem 2007; 100:1440-58. [PMID: 17131366 DOI: 10.1002/jcb.21134] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The aim of this study was to examine the expression of the RBM5 tumor suppressor, in relation to RBM6 and RBM10, to obtain a better understanding of the potential role played by these RBM5-related factors in the regulation of RBM5 tumor-suppressor activity. Paired non-tumor and tumor samples were obtained from 73 breast cancer patients. RNA and protein expression were examined by semi-quantitative reverse transcription-polymerase chain reaction and immunoblot, respectively. Data were analyzed using various statistical methods to test for correlations amongst the RBM5-related factors, and between the factors and various pathological parameters. Most notably, RBM5, RBM10v1, and HER2 protein expression levels were elevated in tumor tissue (P < 0.0001). RBM5 and RBM10v1 protein expression were significantly positively correlated (P < 0.001), as were RBM5 and HER2 protein expression (P < 0.01), in both non-tumor and tumor tissue, whereas RBM10v1 and HER2 protein expression were only marginally correlated, in non-tumor tissue (P < 0.05). Interestingly, RBM5 and RBM10v1 protein expression were both deregulated in relation to RNA expression in tumor tissue. RBM10v2 and RBM6 RNA were highly significantly positively correlated in relation to various factors relating to poor prognosis (P < 0.0001). To our knowledge, this study is the first to examine RBM5 expression at both the RNA and protein level in primary breast tumor tissue, and the first to examine expression of all RBM5-related factors in a comprehensive manner. The results provide a graphic illustration that RBM5-related factors are significantly differentially expressed in breast cancer, and suggest complex inter-related regulatory networks involving alternative splicing, oncogenic expression, and tissue-specific function.
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Affiliation(s)
- Nina D Rintala-Maki
- Tumour Biology Group, Regional Cancer Program, Hôpital Régional de Sudbury Regional Hospital, Sudbury, Ontario, Canada
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Esserman LE, Lamea L, Tanev S, Poppiti R. Should the Extent of Lobular Neoplasia on Core Biopsy Influence the Decision for Excision? Breast J 2007; 13:55-61. [PMID: 17214794 DOI: 10.1111/j.1524-4741.2006.00363.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to determine whether there is a criterion that can be utilized to determine if excisional biopsy is indicated following the diagnosis of lobular neoplasia (LN) on core biopsy. Retrospective review of patient records with diagnosis of LN as highest risk diagnosis on core biopsy was performed. LN was defined to include both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) and was categorized as focal or diffuse. The pathology was correlated with the mammographic finding to determine whether the diagnosis of LN was incidental or related to the mammographic finding. For those patients who did not undergo excision, follow-up data are presented along with treatment information. A total of 4,555 breast core biopsies were performed at our institution from January 1997 through March 2005. Of these, 35 patients were diagnosed with LN. Twenty six (74%) went on to excision and nine (26%) were followed. Biopsy was recommended for mammographically detected calcifications in the majority of cases. Twenty four (92%) of the 26 excised cases had focal LN and 2 of 26 (8%) had diffuse LN. Infiltrating lobular carcinoma was diagnosed in both cases of diffuse LN and no infiltrating carcinoma was seen when focal LN was diagnosed on core. Excision may not be necessary when a diagnosis of only focal LN is made on core biopsy. Diffuse LN may indicate an associated invasive cancer and should prompt excision.
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Affiliation(s)
- Lisa E Esserman
- Breast Imaging, Mount Sinai medical Center, Miami Beach, Florida 33140, USA.
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Dillon MF, McDermott EW, Hill AD, O'Doherty A, O'Higgins N, Quinn CM. Predictive Value of Breast Lesions of “Uncertain Malignant Potential” and “Suspicious for Malignancy” Determined by Needle Core Biopsy. Ann Surg Oncol 2006; 14:704-11. [PMID: 17151788 DOI: 10.1245/s10434-006-9212-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Revised: 07/22/2006] [Accepted: 07/27/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimum management of patients whose needle core biopsy (NCB) results are of "uncertain malignant potential" (B3) or "suspicious for malignancy" (B4) is unclear. This study correlates B3 and B4 NCB findings with excision histology to determine associated rates of malignancy. METHODS All NCBs categorized as B3 or B4 were identified from a series of 3729 NCBs. Results of biopsies were reported as normal/nondiagnostic (B1), benign (B2), uncertain malignant potential (B3), suspicious but not diagnostic of malignancy (B4), or malignant (B5) according to the B classification system. B3 lesions included atypical intraductal epithelial proliferations (AIEPs), lobular neoplasia, papillary lesions, radial scars, and potential phyllodes tumors. Histological concordance between NCB and excision specimen was analyzed. RESULTS A total of 211 B3 lesions and 51 B4 lesions were identified during the study period. The open biopsy rate after a B3/B4 finding was 86% (n = 226). The overall rate of malignancy for B3 lesions after excision was 21%. The B3 lesion-specific rates of malignancy were 6% for radial scars, 14% for papillomas, 35% for AIEP, and 44% for lobular neoplasia. Of the patients with a B4 categorization, 90% (44 of 49) were diagnosed with carcinoma after surgery. Those that were "suspicious for ductal carcinoma-in-situ" and "suspicious for invasion" correlated accurately with excision findings in 81% and 89% of patients, respectively. CONCLUSIONS Management of lesions in the B3 categorization must be tailored to the patient because the specific lesion types are associated with highly variable rates of malignancy. A repeat biopsy or a therapeutic wide local excision should be undertaken in lesions with a B4 NCB categorization because such lesions are associated with a particularly high risk of malignancy at excision.
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Affiliation(s)
- Mary F Dillon
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Jolly S, Kestin LL, Goldstein NS, Vicini FA. The impact of lobular carcinoma in situ in association with invasive breast cancer on the rate of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2006; 66:365-71. [PMID: 16965988 DOI: 10.1016/j.ijrobp.2006.05.070] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 05/03/2006] [Accepted: 05/04/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE The significance of lobular carcinoma in situ (LCIS) associated with invasive breast cancer in patients undergoing breast-conserving therapy (BCT) remains controversial. We examined the impact of the presence and extent of LCIS associated with invasive breast cancer on clinical outcome in BCT patients. METHODS AND MATERIALS From 1980 to 1996, 607 cases of invasive breast cancer were treated with BCT. All slides were reviewed by a single pathologist. Positive margin was defined as presence of invasive carcinoma/ductal carcinoma in situ at the inked margin. Multiple clinical, pathologic, and treatment-related variables were analyzed for their association with ipsilateral breast tumor recurrence (IBTR) and true recurrence/marginal miss (TR/MM). Median follow-up was 8.7 years. RESULTS Fifty-six patients (9%) had LCIS in association with invasive cancer. On univariate analysis, positive final margin, positive/no reexcision, smaller maximum specimen dimension, and the presence of LCIS predicted for IBTR. The 10-year IBTR rate was 14% for cases with LCIS vs. 7% without LCIS (p=0.04). On multivariate analysis, positive margin (p<0.01), positive/no reexcision (p=0.04), and presence of LCIS (p=0.02) remained independently associated with IBTR; positive margin (p<0.01) and LCIS (p=0.04) were also associated with TR/MM failure. When examining only cases with negative final margins, the presence of LCIS remained associated with higher IBTR and TR/MM rates (p<0.01). CONCLUSION The presence of LCIS was independently associated with higher rate of IBTR and TR/MM after BCT for invasive breast cancer. LCIS may have significant premalignant potential and progress to an invasive IBTR at the site of index lesion. The adequacy of excision of LCIS associated with invasive carcinoma should be considered in patients undergoing BCT.
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Affiliation(s)
- Shruti Jolly
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
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Eisinger F, Bressac B, Castaigne D, Cottu PH, Lansac J, Lefranc JP, Lesur A, Noguès C, Pierret J, Puy-Pernias S, Sobol H, Tardivon A, Tristant H, Villet R. [Identification and management of hereditary breast-ovarian cancers (2004 update)]. ACTA ACUST UNITED AC 2006; 54:230-50. [PMID: 16632260 DOI: 10.1016/j.patbio.2006.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Accepted: 02/04/2006] [Indexed: 12/24/2022]
Abstract
BACKGROUND Since the last recommendations, up to 2500 new references had been published on that topic. METHODOLOGY On the behalf of the health Minister, the Ad Hoc Committee consisted of 13 experts carried out a first version revisited by five additional experts who critically analyzed the first version of the report. MAIN UPDATING Breast and ovarian cancer seem to be associated with fewer deleterious mutations of BRCA1 and BRCA2 than previously thought. The screening of ovarian cancer is still not an attractive option while in contrast MRI may be soon for these young women with dense breast, the recommended option for breast cancer screening. The effectiveness of prophylactic surgeries is now well established. French position is to favor such surgeries with regard to a quality of life in line with the expected benefit, and providing precise and standardized process described in the recommendation. CONCLUSIONS Due to methodological flaws, the low power and a short follow-up of the surveys, this statement cannot however aspire to a high stability.
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Affiliation(s)
- F Eisinger
- Département d'oncogénétique, institut Paoli-Calmettes, Marseille, France.
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Allen-Brady K, Camp NJ, Ward JH, Cannon-Albright LA. Lobular breast cancer: excess familiality observed in the Utah Population Database. Int J Cancer 2005; 117:655-61. [PMID: 15929077 DOI: 10.1002/ijc.21236] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Family history of breast cancer (BC) is a strong predictor for developing female BC. Whether this excess familiality differs within morphological BC subgroups remains unclear. We assessed the risk of lobular breast cancer (LOB) and any BC among relatives of probands with LOB. We used the Utah Population Database (UPDB) to estimate familial relative risks (FRR) as well as average relatedness, using the genealogical index of familiality (GIF) statistic. The UPDB, a population-based resource, links genealogical data from over 2 million individuals to the Utah Cancer Registry. Consistent with other studies, analysis of all BC cases showed significantly increased risk of BC to relatives (first-degree relative [FDR]: FRR = 1.83, 95% confidence interval [CI] = 1.75-1.90). Morphology-specific risks showed that relatives of LOB probands had an increased risk of LOB (FDR: FRR = 4.51, 95% CI = 2.79-6.89) and an increased risk of any BC (FDR: FRR = 2.47, 95% CI = 2.12-2.85); both measures were significantly greater than the all BC FRR estimates, and surpassed even generalized early-onset BC risk. GIF analyses corroborated the FRR results and indicated that the excess relatedness of LOB cases extended to third-degree relatives. Our findings suggest that LOB has a heritable component and may represent a genetically homogeneous form of BC. Pedigrees with excess LOB may be useful in isolating additional BC predisposition genes. Relatives of women with LOB are at higher risk for BC than relatives of other BC subtypes; a more rigorous BC screening regime may be warranted for these individuals.
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Affiliation(s)
- Kristina Allen-Brady
- Genetic Epidemiology, Department of Medical Informatics, University of Utah School of Medicine, Salt Lake City, 84108, USA.
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Wárlám-Rodenhuis CC, Koot VCM, van der Luijt RB, Vasen HFA, Ausems MGEM. A prospective study on predictive factors linked to the presence of BRCA1 and BRCA2 mutations in breast cancer patients. Eur J Cancer 2005; 41:1409-15. [PMID: 15955690 DOI: 10.1016/j.ejca.2005.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Revised: 02/08/2005] [Accepted: 02/21/2005] [Indexed: 11/26/2022]
Abstract
We prospectively screened a hospital-based population of 1000 successive breast cancer patients receiving adjuvant radiotherapy for predictive factors associated with the presence of BRCA1 and BRCA2 mutations. We offered genetic counseling and DNA analysis to selected patients. About 52% of patients showed at least one presumed predictive factor. Hundred and thirty-seven patients underwent DNA analysis. We identified 14 deleterious mutations (10.2%, 95% CI: 5.2-15.3%): 8 BRCA1 mutations and 6 BRCA2 mutations and 14 variants of uncertain clinical significance. Ovarian cancer in the family history was the only factor significantly associated with the presence of a disease-causing mutation (P < 0.01). Eight of the 14 (57%) mutation carriers had no affected first-degree relatives and in 4 of these there was no family history of breast or ovarian cancer. Clinicians should offer genetic counseling and DNA testing to breast cancer patients from families with breast and ovarian cancer, and to patients who are younger than 45 years when they are diagnosed with breast cancer.
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Stein LF, Zisman G, Rapelyea JA, Schwartz AM, Abell B, Brem RF. Lobular Carcinoma In Situ of the Breast Presenting as a Mass. AJR Am J Roentgenol 2005; 184:1799-801. [PMID: 15908533 DOI: 10.2214/ajr.184.6.01841799] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lauren F Stein
- Department of Radiology, The George Washington University Medical Center, 2150 Pennsylvania Ave., Washington, DC 20037, USA
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Foster MC, Helvie MA, Gregory NE, Rebner M, Nees AV, Paramagul C. Lobular Carcinoma in Situ or Atypical Lobular Hyperplasia at Core-Needle Biopsy: Is Excisional Biopsy Necessary? Radiology 2004; 231:813-9. [PMID: 15105449 DOI: 10.1148/radiol.2313030874] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively determine frequency of invasive cancer or ductal carcinoma in situ (DCIS) at excisional biopsy in women with atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) at percutaneous core-needle biopsy (CNB). MATERIALS AND METHODS Review of results in 6,081 consecutive patients who underwent CNB at two institutions revealed that in 35 (0.58%), LCIS (n = 15) or ALH (n = 20) was the pathologic finding with highest risk. Patient age range was 41-84 years (mean, 59 years). Of 35 patients, 26 (74%) underwent excisional biopsy and nine (26%) underwent mammographic follow-up for longer than 2 years. Lesions with a pathologic upgrade were noted when invasive cancer or DCIS occurred at the CNB site. CNB results in patients with a diagnosis of atypical ductal hyperplasia (ADH) (75 of 6,081 [1.2%]) were reviewed; these patients underwent subsequent excisional biopsy. Statistical comparison of frequency of upgrading of lesions in patients with a diagnosis of LCIS or ALH at CNB and in those with a diagnosis of ADH at CNB was performed (Pearson chi(2) test). RESULTS In six (17%) of 35 (95% CI: 4.7%, 29.6%) patients, lesions were upgraded to DCIS (n = 4) or invasive cancer (n = 2). In 15 patients with LCIS diagnosed at CNB, lesions in four (27%) were upgraded to either DCIS or invasive cancer. In 20 patients with ALH diagnosed at CNB, lesions were upgraded to DCIS in two (10%). Lesions in nine patients who underwent mammographic follow-up were stable. No mammographic or technical findings distinguished patients with upgraded lesions from those whose lesions were not upgraded. In 12 (16%) of 75 (95% CI: 7.7%, 24.3%) patients with ADH, lesions were upgraded. Difference between the upgrade rate in patients with LCIS or ALH and that in those with ADH was not significant (P =.88). CONCLUSION Lesions in 17% of patients with LCIS or ALH at CNB were upgraded to invasive cancer or DCIS; this rate was similar to the upgrade rate in patients with ADH. Excisional biopsy is supported when LCIS, ALH, or ADH is diagnosed at CNB.
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Affiliation(s)
- Michelle C Foster
- Department of Radiology, TC 2910N, University of Michigan Health System, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0326, USA
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El Hanchi Z, Berrada R, Fadli A, Ferhati D, Brahmi R, Baydada A, Kharbach A, Chaoui A. Cancer du sein bilatéral. Incidence et facteurs de risque. ACTA ACUST UNITED AC 2004; 32:128-34. [PMID: 15123135 DOI: 10.1016/j.gyobfe.2003.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2001] [Accepted: 01/30/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To clarify, thanks to a retrospective study of 24 bilateral breast cancer cases, the frequency, the risk factors and the prognosis of bilateral breast cancers. PATIENTS AND METHOD Between 1984 and 1999, out of 506 patients treated for unilateral non-metastatic breast cancer at Gynecologic and Obstetric ward, at Maternity Souissi of Rabat, 24 cases of bilateral breast cancers were diagnosed. Our results were compared to those of the literature. RESULTS The frequency of bilateral breast cancers was 4.7% (24/506). In 87.5% of cases, these were metachronous cancers with a mean interval of 45 months (12-144 months). Patients under 40 at first cancer ran a fivefold superior risk than women more than 40 (P < 0.05). In cases of T3 or T4 tumors, the risk was 10-fold superior to that in smaller ones (P < 0.05). DISCUSSION AND CONCLUSION Significantly more first metachronous tumors were invasive adenocarcinoma cancers. Histologic type of first and second tumor was the same in all cases. The prognosis depends at once on the first and second cancer staging and the treatment must be done according to the same rules as in the first cancer.
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Affiliation(s)
- Z El Hanchi
- Service de gynécologie-obstétrique, maternité universitaire Souissi M 1, CHU Ibn-Sina de Rabat, Tunisia.
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Abstract
Breast cancer is the most commonly diagnosed cancer in women. The risk of developing breast cancer can be lowered by maintaining a healthy bodyweight and avoiding long-term use of combined estrogen and progestogen replacement after menopause. However, many women are at an increased risk of developing breast cancer secondary to age, early menarche, a family history of breast cancer or a personal history of benign breast disease. These women may now be offered tamoxifen as a chemoprevention therapy. Five years of tamoxifen treatment results in a reduction in the relative risk of developing estrogen receptor-positive breast cancer of 48%. This benefit outweighs the risk of tamoxifen-related adverse events for many healthy women. However, the benefit-risk ratio of tamoxifen chemoprevention varies for individual women. The randomized clinical trials evaluating standard-dose tamoxifen versus placebo as chemoprevention therapy are reviewed and analyzed to determine which particular women are most likely to benefit and least likely to experience a tamoxifen-related adverse event. Tamoxifen decreases the risk of breast cancer associated with aging, having a first-degree relative with disease, and a personal diagnosis of atypical ductal hyperplasia or lobular carcinoma in situ. Women who have had a hysterectomy and are at low risk of a thromboembolic event have a decreased risk of adverse effects associated with tamoxifen therapy. The strengths and weaknesses of the Gail model (frequently used to assess an individual's risk of developing invasive breast cancer over the next 5 years) are highlighted. A method for assessing the benefit-risk ratio for an individual woman is presented. Alternative breast cancer chemoprevention strategies are considered, including the use of aromatase inhibitors. This article discusses the pros and cons of these various preventive therapies and concludes that at this time, tamoxifen remains the gold standard for breast cancer prevention.
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Affiliation(s)
- Rita Kramer
- Breast Center, Baylor College of Medicine and the Methodist Hospital, Houston, Texas 77030, USA
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