title: Management of patients diagnosed with lobular carcinoma in situ at needle core biopsy at a community-based outpatient facility.
abstract: OBJECTIVE
  The objective of our study was to show the importance of surgical excision after the diagnosis of lobular carcinoma in situ (LCIS) based on needle core biopsy.
  
  
  METHODS
  Retrospective evaluation of all cases of LCIS diagnosed at needle core biopsy from 2000 to 2011 was performed; 60 patients with 64 diagnoses of LCIS comprise the cohort. Data recorded included patient demographics, patient presentation, breast density, personal and family histories of breast cancer, lesion characteristics, biopsy method, and correlation of core results with surgical pathology or follow-up imaging. The pathology facility was recorded for all biopsies because the specimens from open surgical biopsy were frequently reviewed by a different laboratory.
  
  
  RESULTS
  A total of 60 patients with 64 diagnoses of LCIS comprised the study cohort. The patients ranged in age from 36 to 93 years (average, 55 years). The lesions consisted of 39 calcifications, two masses with calcium, 10 masses, two asymmetries, two architectural distortions, two architectural distortions with calcifications, and seven MRI enhancements. Mammography detected lesions in 84% of the cases (n = 54) and 16% (n = 10) were not visualized. Sonography detected lesions in 30% of the cases (n = 19) and 70% (n = 45) were sonographically occult. Needle core biopsy was performed in all cases: 49 stereotactic biopsies (77%), 12 ultrasound-guided biopsies, and three MRI-guided biopsies. All but one case proceeded to surgery. Open surgical biopsy revealed 21 cancers (33%); of the remaining cases, 53% of the cases (n = 33) were atypical or high risk and 14% (n = 9) were benign.
  
  
  CONCLUSIONS
  The diagnosis of LCIS at needle core biopsy, in this small study, revealed that 84% of lesions either were malignant or were atypical or high risk at surgery, of which 33% were found to be carcinoma. Our findings suggest that LCIS should be excised when noted at core biopsy.
authors.affiliation: Elizabeth Wende Breast Care, LLC, 170 Saw-grass Dr, Rochester, NY 14620, USA. sdestounis@ewbc.com
authors.forename: Stamatia V
authors.initials: SV
authors.lastname: Destounis
authors.forename: Philip F
authors.initials: PF
authors.lastname: Murphy
authors.forename: Posy J
authors.initials: PJ
authors.lastname: Seifert
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Somerville
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Arieno
authors.forename: Renee C
authors.initials: RC
authors.lastname: Morgan
authors.forename: Wende Logan
authors.initials: WL
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary