Stereotactic core biopsy of screen-detected microcalcifications in a 48-year-old woman shows classical lobular carcinoma in situ only, with radiological pathological concordance and clear margins on the specimen. Which statement about her management is correct?
- A She requires completion mastectomy because LCIS carries a very high immediate invasive risk
- B She requires whole breast radiotherapy to the affected breast
- C LCIS is both a risk marker and a non-obligate precursor, so she needs surveillance with annual imaging, and consideration of endocrine prevention rather than further surgery ✓
- D She requires axillary lymph node dissection because LCIS spreads readily to regional nodes
Correct answer: C. LCIS is both a risk marker and a non-obligate precursor, so she needs surveillance with annual imaging, and consideration of endocrine prevention rather than further surgery
Explanation
Classical LCIS found incidentally on core biopsy with concordant imaging is managed without further surgery because it infrequently progresses to invasive carcinoma and does so in either breast. It signals roughly a seven to twelve fold lifetime risk, addressed by surveillance and sometimes tamoxifen for prevention. Radiotherapy and axillary surgery play no role, killing B and D, and mastectomy is reserved for pleomorphic LCIS with extensive disease.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.