Review Question - QID 102781

The woman in the question stem is found to have lobular carcinoma in situ (LCIS). Excisional biopsy is recommended for women found to have LCIS.

LCIS is not considered a premalignant lesion, but is instead regarded as a risk factor for breast cancer. In fact, LCIS raises a woman's risk for breast cancer in both breasts. However, because LCIS may progress to invasive cancer in a subset of patients, excisional biopsy is recommended in patients who have multiple foci of LCIS (>4) or who are otherwise at high risk for developing breast cancer. Low-risk patients with LCIS discovered incidentally may choose between surveillance, chemoprevention, and bilateral prophylactic mastectomy.

Rendi et al. reviews the treatment of LCIS in high-risk patients. "Women with a CNB diagnosis of LN for calcifications found on routine, normal-risk mammographic screening have a negligible risk of upgrade and may not require excisional biopsy. However, excisional biopsy should be offered to women undergoing imaging for other indications or with >4 foci of LN on CNB."

Oppong et al. provides general guidelines for the treatment of LCIS. "Today, a diagnosis of LCIS remains one of the greatest identifiable risk factors for the subsequent development of breast cancer. As such, patients are offered one of three options: (1) lifelong surveillance with the goal of detecting subsequent malignancy at an early stage; (2) chemoprevention; or (3) bilateral prophylactic mastectomy."

Incorrect answers:
Answer 1: Surveillance is an option for women with LCIS with otherwise low risk for breast cancer.
Answer 2 and 3: Radiation and chemotherapy are alternative treatments for LCIS. However, excisional biopsy is the preferred treatment at this time.
Answer 5: A PET-CT scan may be used for the detection of malignancy or metastasis but is not indicated in this patient.